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Workers Compensation Claims Adjuster II
Intercare Holdings Insurance ServicesWorkers Compensation Claims Adjuster managing claims for AvonRisk. Responsible for claims files and liaison between claimants and medical staff in California.
About the role
Key responsibilities & impact- Reports directly to the unit Claims Supervisor
- Responsible for effectively managing to conclusion an assigned inventory of claim files
- Perform a three-point contact on all new losses within 24 hours of receipt of the claim
- Thoroughly and accurately gather evidence regarding ongoing case facts
- Assure that all assigned indemnity claims have an up to date plan of action
- Form a partnership with the medical case manager to maximize early return to work potential
- Initiate the referral to the SIU of cases with suspected fraud
- Aggressively pursue subrogation from culpable third parties
- Assure that the claim file is handled in accordance with applicable statutes
- Review and approve all vocational rehabilitation plans
- Establish, monitor, and adjust monetary case reserves when warranted
- Review all medical bills for appropriateness prior to referral for payment
- Exhibit and maintain a courteous and helpful attitude
- Respond to telephone messages and inquiries within 24 hours
Requirements
What you’ll need- Bachelor’s degree (B. A.) or equivalent from four-year college
- 3-5 years related experience & training
- 5 years without a SIP certificate
- Equivalent combination of education and experience
- Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims
Benefits
Comp & perks- Comprehensive medical, dental, and vision benefits
- Company contributions to HSA and FSA plans
- Employer paid life and disability insurance
- 401(k) with company match
- Paid time off (PTO) and company paid holidays
- Learning and development opportunities that support real career advancement
- Employee assistance resources and a supportive culture that values balance and wellbeing
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Claims File ManagementEvidence GatheringIndemnity Claims PlanningMonetary Case Reserves ManagementMedical Bill Review
Soft Skills
Courteous AttitudeEffective Communication
Certifications
Bachelor's DegreeSIP Certificate