Workers Compensation Claims Adjuster III
$95,000–$100,000 year
On-site · Salinas, California, United States
Job Summary
Senior Workers' Compensation Claims Adjuster III manages a portfolio of complex indemnity claims, performing a rapid 3-point contact on new losses within 24 hours, and maintains up-to-date plans of action toward claim resolution. The role collaborates with medical case management to maximize early return-to-work potential, pursues subrogation from third parties, and initiates referrals to SIU for suspected fraud. Responsibilities include reviewing medical bills, ensuring compliance with applicable statutes and service contracts, establishing and adjusting reserves, and maintaining professional communication with claimants, employers, and vendors. Requires a Bachelor's degree, at least seven years of related experience (with five+ years managing indemnity cases), and an SIP certificate. Proficiency with California Labor Code, claims handling expertise, and strong problem-solving and customer-service skills are essential.
Required Qualifications
- Bachelor's degree (B. A.) from four-year college or university
- At least seven years related experience and/or training
- Minimum five years experience managing indemnity cases (including complex or high potential subrogation, rehabilitation, medical management, and/or legal issues)
- SIP certificate
- Knowledge of California Labor Code as it pertains to workers compensation claims
- Ability to manage to conclusion an assigned inventory of claim files while ensuring accuracy and compliance
- Three-point contact on new losses within 24 hours
- Ability to establish reserves and monitor monetary case reserves when warranted
- Experience with vendor management, subrogation, and fraud referral processes
- Strong problem solving and customer service skills
- Effective communication and teamwork with medical case management and SIU teams
- Litigation management experience
Desired Qualifications
- Bachelor's degree (B. A.) from four-year college or university
- SIP certificate
- minimum of at least five years experience managing indemnity cases
- at least seven years related experience and/or training
- claims handling expertise
- strong problem solving and customer service skills
- ability to review medical bills and manage subrogation
Apply with one swipe on Sorce. We auto-fill applications and apply on your behalf — no cover letters, no 40-minute forms.
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.