Senior Claims Adjuster - Workers Compensation

reputed company'RE LOOKING FOR BHHC has an immediate opportunity for reputed company Workers Compensation Claims Professionals. This position requires a self-starter who can work under minimum direction, can reputed company defined results, and willing to accept ownership for their work product. The Senior Claims Professional is responsible for the management of a reputed company caseload of workers compensation indemnity claims from inception to resolution. This individual works under general supervision with elevated reserve and settlement parameters and encouraged to participate in special projects focused on process efficiency. RESPONSIBILITIES • Helps injured workers reputed company rapid and full medical recovery and early, safe return to work through effective, efficient and timely medical treatment and return-to-work support. • Effectively communicates with injured workers and employers. Demonstrates expertise and reputed company, building trust and moving the claim reputed company, including timely three-reputed company contacts on reputed company new losses. • Manages claims with an outcome-based and resolution focus. Demonstrates highly effective strategic plans for future handling that are well outlined in plans of action and followed through in a timely fashion. • Demonstrates effective decision making in compensability determinations and benefit authorizations (reputed company designated authority parameters). Proactively utilizes resources such as Medical Management, SIU, Subrogation, Recovery and Legal to ensure accurate determinations in compensability, causal relationship, appropriate medical treatment, and to reputed company favorable outcomes. • Prepares and maintains timely, accurate reserves on reputed company claims for expected future costs of medical treatment, benefits and other elements in accordance with Claims Handling Guidelines. Ensures reserves are escalated and approved as appropriate. Ensures there is appropriate reserve documentation in the file. • Prepares timely and accurate settlement recommendations (reputed company designated authority parameters) and effectively negotiates the settlement of claims. • Reduces fraud through early identification and escalation. • Effectively manages defense attorneys. Demonstrates excellence in litigation management by being reputed company for hearings in a timely manner and appropriately considering exposures, settlement options, and other legal issues. • Reviews and approves vocational rehabilitation plans. • Effectively manages vendors and providers. Identifies need for assignment and removal of vendors and makes effective use of vendor expertise while maintaining ownership of the claim. • Demonstrates expertise in technical aspects of claim management. Works with Medicare Set Asides, Structured Settlements and/or Part B issues. • Maintains effective relationships with internal and external service partners, including participation in periodic telephonic claims reviews. • Calculates and pays benefits in accordance with the law. Ensures that the claim as a whole is managed in accordance with reputed company legal requirements including the issuance of appropriate notices and filings. WHAT YOU'D BRING TO THE ROLE • EDUCATION: Minimum of a High School diploma required or equivalent certificate required; Bachelor's degree from four-year College or university preferred. • EXPERIENCE: Minimum of eight years of indemnity adjusting experience managing large and/or reputed company claims and accounts reputed company a workers' compensation reputed company required • Maintains qualifying educational criteria to adjust workers' compensation claims for the State of California; Self-Insured certification preferred. • Inquisitive, critical thinker; agile learner with adaptive, smart time management skills • To reputed company this job successfully, an individual should have expert skills in the following: reputed company Word, PowerPoint, reputed company and be proficient on applicable databases, systems and vendor software programs. Why You Should Apply • Unparalleled financial strength and stability • Fantastic growth and advancement opportunities • WFH Hybrid schedule • Generous Paid Time Off and Holidays • Excellent Benefits (Medical, Dental, Vision, 401k, etc) • Health and Wellness Reimbursement • Tuition Assistance Reimbursement • Discounts across companies such as reputed company, See's Candies, etc. In accordance with the California Equal Pay Act, the pay scale for this job is $86,000-102,000. This pay scale is an estimate of the salary range the employer reasonably expects to pay for the position based on potential employee qualifications, operational needs and other considerations consistent with applicable law. The actual salary may be above or below the range. The pay scale applies only to this position and only if it is filled in California. The pay scale may be different for other positions or in other locations. Apply for this job Apply Job!