Lost Time Claims Adjuster

Job Title:Lost Time Claims Adjuster

Department: Claims (300)

Supervisor: Claims Manager

FLSA Status: Salary Exempt

Summary:

It is the responsibility of the Lost Time Claims Adjuster to manage all aspects of a workers compensation file. This role requires a CA state adjuster licenses, CA Adjuster Designation and claims handling experience in addition to other Western states.

Essential Duties & Responsibilities:

• Review, examine, analyze and investigate workers compensation claims
• Adjust claims according to state specific statutes and regulations
• Communicate with injured workers to educate them on the workers compensation process and requirements
• Establish claim reserves
• Prepare and issue mandated requirements and documents
• Coordinate medical treatment for injured workers
• Identify cases with subrogation potential and pursue reimbursement
• Act as a liaison between the injured worker, legal counsel and medical providers
• Review and interpret medical reports
• Attend hearings, trials and claim reviews
• Process indemnity payments
• Audit and approve charges related to a workers compensation claim file
• Manage litigation and settlements on a claim file
• Maintain appropriate licenses and certifications
• Perform other duties or special projects as assigned
• Participate in departmental, company and team meetings as needed

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Competencies:

• Ability to operate independently and effectively
• Strong interpersonal and organization skills
• Strong problem solving ability
• Proficient using computer applications including Microsoft Office
• Comfort using internet/online based software
• Detail oriented
• Excellent written and oral communication skills
• Advanced Excel skills
• Strong negotiation skills

Education/Experience:

• Bachelors degree
• CA State issued Adjuster’s license with a willingness to gain in license in additional states
• CA Adjuster Designation
• 2 plus year Workers Compensation Insurance experience preferred
• 2 years Insurance experience
• CA and other Western states workers compensation claims handling experience

Physical Demands:

• Regularly talks throughout the day during both in person conversations and via telephone
• Regularly required to use hands and fingers to handle, feel, or operate objects or tools
• Regularly required to sit for up to 8 or more consecutive hours
• Occasionally lifts up to 10lbs
• Regularly walks through a multi-level office environment
• Regularly types using a computer keyboard for up to 8 hours per day
• Regularly uses a computer mouse for up to 8 hours per day

Work Environment:

• While performing the duties of this job the employee regularly works from their home office.

Schedule/Expected Hours of Work:

• The Lost Time Claims Adjuster will be expected to work Full Time. This schedule will include a minimum of a 37.5 hours per week Monday-Friday to fall between the hours of 7am and 6pm.

Other Duties:

• This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Equal Opportunity Employer:

• Prescient National provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, disability, citizenship, status as a Vietnam-era, special disabled veteran, or other veteran who served on active duty during a war, campaign, or expedition, for which a campaign badge has been authorized, in accordance with applicable federal laws. In addition, Prescient National complies with applicable state and local laws governing nondiscrimination in employment in every location in which Prescient National has employees. This policy applies to all terms and conditions of employment including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfers, leave of absence, compensation and training.

Job Type: Full-time

Pay: $70,000.00 - $100,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Referral program
• Vision insurance
• Work from home

Schedule:

• Monday to Friday

Work setting:

• Remote

Education:

• Bachelor's (Preferred)

Experience:

• Workers' compensation: 2 years (Required)

License/Certification:

• CA Adjuster License & CA Adjuster Designation (Required)

Work Location: Remote