Senior Claims Adjuster
The successful candidate must be experienced in managing California claims at their hire date, as the majority of their claims will be California based. However, they also need to be able to manage Nevada claims, as they will manage Nevada worker's compensation claims as well (about two dozen). The successful candidate needs to be working in Nevada as a home based employee. The target salary is up to $85,000 with a 5% target profit sharing award.
The primary purpose of this position is to successfully manage workers' compensation claims in the California and Nevada jurisdictions with multiple issues and the potential for significant exposure.
The primary responsibilities are:
· Actively manage caseload of complex lost time cases in the California and Nevada jurisdictions.
· Manage diary and complete tasks to ensure that cases move to the best financial outcome and timely resolution. This includes properly scrutinizing both the propriety and efficacy of medical treatment.
· Properly set claim reserves.
· Identify, assign, and coordinate the assignment and coordination of expertise resources to assist in case resolution.
· Applying creative solutions which result in the best financial outcome.
· Processing mail and prioritizing workload.
· Responsible for telephone calls from various parties (insured, claimant, medical facilities, etc.).
· Have an appreciation and passion for strong claim management.
The successful candidate will have the following qualifications:
· A space in your home that can provide a professional atmosphere free from distraction and background noise and other persons, pets, and television.
· Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both the company's and the customers' ability to be profitable).
· Minimum of seven years of successful workers' compensation claim management experience in managing workers' compensation indemnity claims in the California and Nevada jurisdictions.
· Ability from date of hire to legally adjudicate workers' compensation claims in both the California and Nevada jurisdictions.
· Excellent knowledge of workers' compensation law in California and Nevada, particularly as it applies to compensability, causal relationship, and return to work.
· Ability to work independently without need for direct supervision. However, ability to work as a team member on shared goals is also required.
· Must have strong litigation management skills and excellent knowledge of applicable case law.
· Excellent ability to manage complex medical issues.
· Must be experienced in managing rehabilitation issues and identifying and implementing innovative rehabilitation programs.
· Must be innovative in assisting injured workers in finding alternative employment opportunities.
· Ability to prioritize workload and handle multiple tasks.
· Ability to articulate the financial value of your work at multiple responsibility levels inside our clients' business which may include the CEO.
· Exhibit a natural curiosity.
· Desire to work in a fast paced environment.
· Excellent evaluation and strategic skills required.
· Strong claim negotiation skills a must.
· Must possess a strong customer focus.
· Must work independently and demonstrate the ability to exercise sound judgment.
· Proficient in MS Office Suite and other business-related software.
· Polished and professional written and verbal communication skills.
· The ability to read and write English fluently is required. The ability to read and write Spanish fluently is strongly preferred but not required.
· Ability to travel, sometimes overnight, approximately 10% of the time.
· Must demonstrate a desire for continued professional development through continuing education and self-development opportunities.
· Bachelor's degree is not required but considered a significant plus.
In addition, you will share in those core values which are key to our success:
· We desire to excel
· We are committed to our clients and to each other
· We have the courage to do the right thing
· We apply original thinking