The Jonus Group
California Workers Compensation Adjuster
The Jonus Group, San Francisco, California, United States, 94199
California Workers Compensation Adjuster (Permanent)
Job Summary
Seeking a highly skilled and experienced Workers Compensation Claims Adjuster to join a team. This role involves managing all aspects of workers compensation claims, including determining compensability, verifying coverage, administering disability and medical benefits, negotiating claim resolutions, and providing exceptional service to injured employees, employers, and medical/legal professionals.
Compensation Package
Medical, dental, and vision insurance
Life insurance
401(K) with company match
Opportunities for professional growth and development in a supportive and collaborative environment
Responsibilities
Receive and manage newly reported claims
Maintain and update claim notes throughout the lifespan of claims
Record claim information in an electronic database
Conduct interviews with claimants, insureds, medical professionals, and witnesses to determine claim validity
Communicate claim compensability decisions to claimants, employers, and medical providers
Set appropriate reserves based on the nature and extent of injuries
Calculate lost time wages and administer disability payments
Coordinate independent medical examinations and prepare relevant documentation
Maintain regular correspondence with claimants, insureds, and nurse case managers
Review and process medical bills through third-party vendors for additional discounts
Collaborate with claimants and insureds to facilitate early return-to-work
Partner with legal counsel to protect insured interests on litigated claims
Attend settlement conferences, mediations, and hearings on behalf of the company or insured
Review and approve defense attorney bills within authority
Provide relevant loss information to underwriting and risk management teams
Respond to state requests for health cost disputes, applications for hearings, and penalty assessment letters
Identify subrogation opportunities and pursue recovery
Lead claim reviews with clients as requested
Perform other duties as assigned
Qualifications / Requirements
Minimum of 10 years of experience adjusting Workers Compensation Claims in California
SIP Certification is required
Bilingual proficiency in Spanish and English is required
Current with Continuing Education Units (CEUs)
Proficiency in the Microsoft Office suite
In-depth knowledge of California workers compensation laws
Strong understanding of medical terminology and treatment progression
Excellent oral and written communication skills
Exceptional attention to detail and organizational abilities
Proven negotiation skills for resolving issues and settlements
Strong customer service orientation with a commitment to timely responses
Adaptability to changing technologies and new systems
Ability to establish and maintain effective working relationships with others
Seniority Level Mid-Senior level
Employment Type Full-time
Job Function Sales, Business Development, and Finance
Industries Banking, Financial Services, and Insurance
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Seeking a highly skilled and experienced Workers Compensation Claims Adjuster to join a team. This role involves managing all aspects of workers compensation claims, including determining compensability, verifying coverage, administering disability and medical benefits, negotiating claim resolutions, and providing exceptional service to injured employees, employers, and medical/legal professionals.
Compensation Package
Medical, dental, and vision insurance
Life insurance
401(K) with company match
Opportunities for professional growth and development in a supportive and collaborative environment
Responsibilities
Receive and manage newly reported claims
Maintain and update claim notes throughout the lifespan of claims
Record claim information in an electronic database
Conduct interviews with claimants, insureds, medical professionals, and witnesses to determine claim validity
Communicate claim compensability decisions to claimants, employers, and medical providers
Set appropriate reserves based on the nature and extent of injuries
Calculate lost time wages and administer disability payments
Coordinate independent medical examinations and prepare relevant documentation
Maintain regular correspondence with claimants, insureds, and nurse case managers
Review and process medical bills through third-party vendors for additional discounts
Collaborate with claimants and insureds to facilitate early return-to-work
Partner with legal counsel to protect insured interests on litigated claims
Attend settlement conferences, mediations, and hearings on behalf of the company or insured
Review and approve defense attorney bills within authority
Provide relevant loss information to underwriting and risk management teams
Respond to state requests for health cost disputes, applications for hearings, and penalty assessment letters
Identify subrogation opportunities and pursue recovery
Lead claim reviews with clients as requested
Perform other duties as assigned
Qualifications / Requirements
Minimum of 10 years of experience adjusting Workers Compensation Claims in California
SIP Certification is required
Bilingual proficiency in Spanish and English is required
Current with Continuing Education Units (CEUs)
Proficiency in the Microsoft Office suite
In-depth knowledge of California workers compensation laws
Strong understanding of medical terminology and treatment progression
Excellent oral and written communication skills
Exceptional attention to detail and organizational abilities
Proven negotiation skills for resolving issues and settlements
Strong customer service orientation with a commitment to timely responses
Adaptability to changing technologies and new systems
Ability to establish and maintain effective working relationships with others
Seniority Level Mid-Senior level
Employment Type Full-time
Job Function Sales, Business Development, and Finance
Industries Banking, Financial Services, and Insurance
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