About this role
This role manages a full caseload of California workers’ compensation lost time and indemnity claims from inception through resolution. You will conduct investigations, set and maintain reserves, authorize medical care, handle legal/litigation activities, and drive timely settlement outcomes while communicating clearly with injured workers, employers, producers, attorneys, and medical providers.
Key Responsibilities
- Manage lost time and indemnity claims from intake through closure
- Conduct investigations and determine AOE/COE with 24-hour three-point contact
- Establish and maintain reserves based on probable outcomes
- Authorize medical care and ensure timely indemnity benefits
- Handle legal aspects including litigation and settlement negotiations
Technical Overview
Adjuster duties include AOE/COE determination, reserve management, indemnity benefit issuance, diary system administration for timely benefit handling, and claim documentation/reporting. The role uses Microsoft Office Suite and claims management systems and requires proficiency handling litigation and settlement negotiations.
Ideal Candidate
The ideal candidate is a mid-level California workers’ compensation adjuster with multiple years handling lost time and indemnity claims from intake through resolution. They are experienced with AOE/COE investigations, reserve setting, three-point contact within 24 hours, and managing litigation and settlements, with strong customer service communication and proficiency in Microsoft Office and claims systems.
Must-Have Skills
California Workers’ Compensation experience is requiredMultiple years of experience handling Workers’ Compensation claimsincluding indemnity and litigated claimsWCCA or WCCP designationCalifornia Self-Insured CertificationProficiency with Microsoft Office Suite and claims management systemsAbility to independently manage a caseload in a fast-paceddeadline-driven environmentConduct and direct investigations to determine AOE/COETimely 24-hour three-point contact with injured workersemployersand medical providers
Tools & Platforms
Microsoft Office Suite
Required Skills
Workers’ Compensation indemnity claimsWorkers’ Compensation lost time claimsAOE/COE investigationsreservesmedical care authorizationindemnity benefitsdiary systemlitigationsettlement negotiationssettlement value determinationMicrosoft Office Suiteclaims management systemsCalifornia Self-Insured CertificationWCCAWCCPthree-point contact
Hard Skills
Workers’ Compensation lost time claimsWorkers’ Compensation indemnity claimsClaims handlingInvestigations to determine AOE/COEReserves establishment and maintenanceMedical care authorizationIndemnity benefits issuanceAOE/COE analysisLitigation managementSettlement negotiationsDiary system for benefit administrationClaim settlement value determinationWritten and verbal claim communicationMicrosoft Office SuiteClaims management systemsCalifornia Self-Insured CertificationCalifornia Workers’ Compensation experienceWCCA or WCCP designationThree-point contact within 24 hoursClaim documentation and reportingEmployer and medical provider communicationProducers (insurance producers) communication
Soft Skills
Strong customer service focusClear and professional written communicationClear and professional verbal communicationOrganizational skillsProblem-solvingDecision-makingAbility to work independentlyAdaptabilityTime management (deadline-driven environment)
Certifications
Required
WCCA (designation)WCCP (designation)California Self-Insured Certification
Keywords for Your Resume
Workers' Compensation Lost Time AdjusterLost Time AdjusterWorkers’ Compensation Lost Time claimsWorkers’ Compensation indemnity claimsclaims handlingAOE/COE24-hour three-point contactinjured workersemployersmedical providersreservesinitial reservesmedical care authorizationindemnity benefitsdiary systemlitigationlitigation and settlement negotiationssettlement valuecustomer serviceMicrosoft Office Suiteclaims management systemsCalifornia Workers’ CompensationCalifornia Self-Insured CertificationWCCAWCCPWorkers' Compensation claimsproducersremote positionCalifornia Workers’ Compensation experienceWorkers’ Compensation lost time claims
Deal Breakers
California Workers’ Compensation experience is required, WCCA or WCCP designation required, California Self-Insured Certification required
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