Experienced Claims Adjuster (Workers Compensation)

Location: San Diego, California; hybrid workplace with work from home available up to two days per week.

Salary: $70,304–$95,130 per year.

Company

Workers compensation insurance operations supporting insureds, injured workers, medical providers, legal professionals, and partner company teams.

What you will do

• Manage a caseload of workers compensation indemnity claims from inception through resolution.
• Investigate reported claims, determine coverage and compensability, assess severity, and document findings.
• Calculate and adjust reserves, administer statutory benefits, and issue required notices and filings.
• Develop and update claim resolution plans while coordinating medical care, attorneys, nurse case managers, investigators, and vendors.
• Prepare litigation, AOE/COE investigation, MSA, and settlement referrals; recommend and negotiate settlements within authority limits.
• Collaborate with claims, medical management, client services, underwriting, legal, and other departments on claim handling and process-efficiency projects.

Requirements

• Minimum three years of indemnity adjusting experience managing large or complex workers compensation claims and accounts within a workers compensation carrier.
• California claims adjuster designation or experienced claims adjuster designation, with the continuing education required to adjust workers compensation claims in California.
• High school diploma or equivalent; a bachelor's degree is preferred.
• Critical-thinking, investigative, decision-making, organization, and time-management skills, with the ability to work under minimum direction.
• Proficiency with Microsoft Office and applicable databases, systems, and vendor software; advanced Excel proficiency is preferred.
• Self-insured certification is preferred.

Culture & Benefits

• Work-life balance and a reasonable caseload with in-house medical management and claims assistant support.
• Paid time off, paid holidays, retirement savings match, and tuition reimbursement.
• Medical, dental, vision, life, AD&D, long-term disability, accident, and critical illness insurance.
• Flexible savings accounts, employee assistance program, and community volunteer day.
• Free on-site fitness facility and garage parking.
• Diversity, equity, and inclusion program and employee referral program.