CA Work Comp Adjuster

A well-established insurance organization is seeking an experienced Senior CA Workers' Compensation Adjuster to join its California claims team. This role is responsible for managing complex workers' compensation claims, including litigated and high-exposure files, while serving as a key resource to internal stakeholders and junior claims professionals.

Position Overview

The Senior Workers' Compensation Adjuster will independently handle moderate to complex workers' compensation claims from investigation through resolution. The ideal candidate will possess strong analytical, negotiation, and litigation management skills, along with extensive knowledge of California workers' compensation regulations and best practices.

Key Responsibilities

• Independently manage a caseload of moderate to complex workers' compensation claims.
• Conduct thorough investigations, evaluate compensability and coverage, and issue appropriate claim documentation.
• Set and maintain accurate reserves and authorize payments within designated authority.
• Collaborate with defense counsel, medical professionals, vendors, and other stakeholders to develop effective claim strategies.
• Manage litigated claims and negotiate favorable claim resolutions.
• Ensure compliance with all jurisdictional requirements and internal claim handling standards.
• Maintain detailed claim documentation and prepare comprehensive reports.
• Analyze claim trends and leverage technology and data to support effective claim outcomes.
• Provide mentorship and guidance to less experienced claims professionals.
• Participate in training initiatives and contribute to continuous process improvement efforts.

Qualifications

• Bachelor's degree preferred; equivalent experience will be considered.
• 5+ years of workers' compensation claims handling experience within an insurance carrier environment.
• Strong knowledge of California workers' compensation laws, regulations, and procedures.
• Experience managing litigated and complex claims.
• Ability to obtain and maintain required adjuster licensing and continuing education requirements.
• Excellent negotiation, communication, and customer service skills.
• Strong organizational and time-management abilities with proven desk management experience.
• Demonstrated ability to work independently in a fast-paced environment while managing competing priorities.