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Senior Claims Adjuster
2 months ago
Method Workers' Compensation LLC is seeking a highly skilled Senior Claims Adjuster to join our team in California. As a Senior Claims Adjuster, you will be responsible for analyzing claims to determine benefits due, ensuring the ongoing adjudication of claims within service expectations, industry, and company best practices, and identifying subrogation of claims and negotiating settlements.
Key Responsibilities:- Promptly investigate, evaluate, and manage workers' compensation claims beginning with coverage evaluation, compensability determination, and recovery.
- Manage the medical and return to work process throughout the life of the claim.
- Exercise discretion and independent judgment with respect to evaluating and managing claims and determining reserve amounts.
- Evaluate exposure of claims by reviewing medical records and claim facts to develop and calculate appropriate reserves as well as manage reserve adequacy throughout the life of the claim.
- Adhere to Method Best Practices, Method Claims Protocol, and Claims Handling Guidelines.
- Maintain appropriate claim file documentation and claim coding is complete and accurate.
- Communicate claim activity regularly to any relevant internal and external stakeholders, including injured workers, policyholders, medical providers, and legal counsel, if appropriate.
- Prepare timely any state filings within the state statutory regulations.
- Calculate the average weekly wage and indemnity benefits owed.
- Approve medical and expense payments.
- Ensure all benefits are paid timely.
- Ensure timely and cost-effective claims resolution; negotiate settlement of claims within adjusters' assigned authority when appropriate.
- Manage the litigation process and work with legal counsel when necessary.
- Coordinate vendor utilization while considering claim cost containment techniques and outcomes, including but not limited to nurse case management, surveillance, etc.
- Manage claim recoveries, including but not limited to subrogation and Medicare offsets.
- Notify management of large loss, denial, coverage disputes, subrogation potential, or other matters requiring escalation or collaboration.
- Maintain knowledge of jurisdictional requirements and applicable case law, including appropriate licensure and continuing education requirements.
- In-depth knowledge of workers' compensation insurance principles and laws, as well as cost containment principles.
- Detail-oriented with the ability to work in a team environment.
- Excellent customer service, written and verbal communication skills.
- Ability to prioritize and balance multiple projects simultaneously.
- Results-driven, proactive, and able to work autonomously.
- Ability to exercise discretion and independent judgment.
- Proficient in Microsoft Office Suite, PDF Professional, G Suite, or similar software.
- Bachelor's degree from an accredited college or university.
- At least 5 years of experience in workers' compensation claims experience.
- A combination of education and experience in an insurance company (TPA or brokerage environment) will be considered.
- State adjuster's licenses as required.
In exchange for your time and expertise, we offer competitive compensation, 401(k) plus matching, health benefits (including HSA Contribution), paid disability, paid parental leave, professional development opportunities, and a hybrid/remote work environment. This is an opportunity to play a key role in the continued success of a growing organization.
Method Workers' Compensation LLC is an equal opportunity employer regardless of race, color, gender, age, sexual orientation, gender identity, gender expression, religious beliefs, marital status, genetic information, national origin, disability, protected veteran status, or any other basis protected by federal, state, or local law.
