Workers Compensation Claims Adjuster Job in Sacramento, California Us

The Workers Compensation Claims Analyst will deliver effective claims support to customers by investigating claims, determining coverage, and making recommendations on legal issues to determine claim outcomes.   This position will manage a workload of multiple jurisdiction claim files. This is located in Sacramento, CA.

 

Essential Job Responsibilities:

Technical Performance

·         Manage a portfolio of assigned Workers Compensation claims up to a stated financial level providing efficient, effective, and reliable claims services, and ensuring timely resolution

·         Conduct and coordinate loss investigations on all assigned claims to provide accurate facts for disposition

·         Evaluate and negotiate the resolution of claims, while mitigating damages, to achieve cost effective claim outcomes

·         Negotiate the settlement of assigned claims within authorized amounts or specific file authority to produce appropriate outcomes

·         Review reserves on all assigned claim files and recommend changes where necessary to ensure actuarial accuracy

·         Identify and refer claims to the appropriate Center of Expertise (COE) in a timely manner to maximize claim outcome

·         Take ownership for personal development and career planning, and development of required skills, tools, techniques, and technology to continually add value to the organization

·         Provide accurate and timely information to all external and internal stakeholders to address claim status and other inquiries such as questions on fraud, subrogation recovery, reserve adequacy, and underwriting risks

 

Strategy and Planning

·         Contribute to projects and planning surrounding departmental initiatives to meet strategy objectives

 

Policy, Process, and Procedures

·         Undertake claims resolution activities in accordance with the claim best practices and Department of Insurance (DOI) compliance to support quality claim results

 

Environmental Awareness/Customer Focus

·         Maintain work practices within the claims function to ensure a “no surprises” culture

·         Provide the highest level of customer care, responsiveness, and satisfaction when managing assigned claims to produce the best claim outcomes

·         Direct, control, and manage relationships with vendors to deliver accurate, timely, and cost effective solutions

 

 

Required Education and/or Experience:

·         Bachelor’s degree or equivalent work experience in Business, Insurance, or related field

·         Claims continuing education such as INS

 

Experience Required

·         At least 3 years of relevant claims experience handling Workers Compensation claims multiple jurisdictions.

·         Litigation and complex file background

 

Preferred Qualifications

·         Progress toward AIC, CPCU or other relevant designations.

·         Workers Compensation Experience in multiple jurisdictions

·         Variety of state adjuster licenses

 

Job Related Knowledge and Skills:

·         Demonstrated knowledge of claims handling processes, systems, and regulatory requirements

·         Demonstrated understanding of policy and contract language

·         Demonstrated customer service experience

·         Ability to utilize various technology platforms

·         Articulate oral and written communication

·         Ability to negotiate and compromise conflict situations

·         Investigation and decision making skills

 

To apply, please visit www.qbeamericas.com, and apply to Job ID: 22617.