Workers Compensation Adjuster-CA license

Must be licensed in CA.
Work is remote. Must be on East Coast time.

Seeking a Workers’ Compensation Lost Time Adjuster who brings strong technical expertise, sound judgment, and a proactive approach to managing indemnity and medical-only claims. This role manages Workers’ Compensation claims from intake through resolution and may support lost time claim. As the Workers' Compensation Lost Time Adjuster, you will investigate, evaluate, and manage claims in accordance with company guidelines, client expectations, and jurisdictional requirements.

To be successful in this role you must have municipality/public entity experience, along with presumption experience.

Key Responsibilities

Claim Ownership & Adjudication

• Manage Workers’ Compensation claims from intake through closure
• Determine compensability and benefit eligibility
• Establish and adjust reserves based on claim exposure

Investigation & Case Management

• Conduct investigations, including interviews and documentation review
• Develop and execute claim strategies
• Identify opportunities for early resolution

Medical & Indemnity Management

• Monitor treatment plans and coordinate return-to-work efforts
• Administer indemnity benefits in compliance with jurisdictional requirements

Litigation Management

• Coordinate with defense counsel on litigated claims
• Support hearings, mediations, and settlements

Client Communication & Compliance

• Provide timely updates to clients and stakeholders
• Ensure compliance with all state regulations and internal standards

Skills, knowledge & expertise

• 3+ years of Workers’ Compensation claims handling experience
• Experience with medical-only, lost time, or blended Workers’ Compensation claim portfolios preferred
• Must have active CA license
• Must have presumption experience
• Strong knowledge of Workers’ Compensation laws, benefit structures, and claims processes
• Experience managing indemnity payments and return-to-work programs
• Ability to handle multiple claims in a fast-paced environment
• Strong investigative, analytical, and decision-making skills
• Effective negotiation and problem-solving abilities
• Excellent written and verbal communication skills
• Proficiency with claims management systems and related technology
• Active adjuster license(s) or ability to obtain as required

Preferred

• Experience with EDI reporting and jurisdictional compliance requirements
• Familiarity with nurse case management and medical cost containment strategies