Claims Adjuster - Workers Compensation

Job Description

Claims Adjuster II – California Workers’ Compensation

Locations: Los Angeles, CA | Walnut Creek, CA | Portland, OR | Downers Grove, IL

Schedule: Hybrid – 2 days onsite / 3 days remote

Hours: Monday–Friday, 8:00 AM–5:00 PM CST

Pay Rate: $60–$65/hour

Employment Type: 6-Month Contract with Potential for Extension or Conversion

Position Overview

We are conducting a confidential search for an experienced Workers’ Compensation Claims Adjuster to join the claims organization of a large, established insurance company. This position is specifically focused on California Workers’ Compensation claims and requires hands-on experience managing complex and litigated files. The ideal candidate will have at least 3–5 years of direct California Workers’ Compensation claims experience and a current California claims certification. This is not an entry-level or general claims position. We are seeking an adjuster who can independently manage claims from investigation through resolution, including reserves, medical management, litigation strategy, settlement negotiations and coordination with attorneys and other claims partners.

Key Responsibilities

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• Independently manage a portfolio of California Workers’ Compensation claims, including complex and litigated matters
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• Review policy coverage and determine applicability to submitted claims
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• Establish and maintain appropriate claim reserves and authorize payments within assigned authority
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• Conduct claim investigations through communication with insureds, claimants, witnesses, medical professionals and other involved parties
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• Evaluate claims for compensability, exposure and appropriate resolution strategy
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• Partner with attorneys, physicians, nurse case managers, insureds and internal business partners to develop effective claim strategies
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• Manage litigation activity and identify opportunities for timely, cost-effective claim resolution
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• Develop and negotiate settlement strategies and packages
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• Monitor medical treatment and other factors affecting claim exposure and resolution
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• Identify potential fraud and coordinate referrals to appropriate investigative resources
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• Recognize potential third-party recovery and subrogation opportunities
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• Maintain accurate and thorough claim documentation
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• Remain current on California Workers’ Compensation regulations, requirements and industry developments
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Required Qualifications

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• 3–5+ years of direct California Workers’ Compensation claims handling experience required
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• Current California claims certification required
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• Demonstrated experience managing complex and/or litigated Workers’ Compensation claims required
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• Hands-on experience establishing and evaluating reserves
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• Strong background in claim investigations, settlements and negotiations
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• Experience coordinating medical management and working with attorneys, physicians and nurse case managers
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• Strong knowledge of Workers’ Compensation claims practices and insurance principles
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• Ability to independently evaluate claim exposure and make sound claims decisions
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• Strong analytical, organizational and problem-solving skills
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• Excellent written and verbal communication skills
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• Ability to effectively manage multiple claims, priorities and deadlines
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Preferred Qualifications

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• Bachelor’s degree or equivalent professional experience
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• Professional insurance or claims designations
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• Experience handling high-exposure or particularly complex California Workers’ Compensation files
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Work Arrangement

This position follows a hybrid schedule of two days onsite and three days remote per week, with Wednesday as a required onsite day.

Candidates must be able to work from one of the following markets:

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• Los Angeles, California
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• Walnut Creek, California
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• Portland, Oregon
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• Downers Grove, Illinois
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