Job Description

Job Description

Job Description

Job Profile

Job Title

Workers Compensation Claims Adjuster (1367280)

Location

Remote

Hire Type

Contingent

Hourly

$46.42 - $50

Work Model

Monday – Friday

Contact Phone

(443)-345-3305

Contact Email

sean@marykraft.com

Nature & Scope :

Positional Overview

Mary Kraft is seeking an experienced Workers Compensation Claims Adjuster, based in California, to manage and adjudicate mid- and higher-level workers’ compensation claims, ensuring compliance with company standards and industry best practices. This role requires expertise in California WC claims handling, a minimum of 3 years of experience as an indemnity examiner, and the ability to assess and process claims efficiently. Knowledge of public entity claims and a SIP certification are preferred but not required.

Role & Responsibilit y:

Tasks That Will Lead To Your Success

• Manage workers' compensation claims by determining compensability and benefits due on long-term indemnity claims, monitoring reserves, and filing necessary documentation with state agencies.
• Develop and manage action plans to efficiently resolve claims, coordinate return-to-work efforts, and approve claim payments.
• Process and approve assigned claims, determine benefits due, and manage actions according to client contracts.
• Identify subrogation opportunities and negotiate settlements where appropriate.
• Communicate claim actions and progress with claimants and clients to maintain strong, professional relationships.
• Ensure proper documentation and correct coding of claim files.
• Manage complex claims, including lifetime or defined period medical claims, with involvement in state and physician filings and treatment reviews as needed.
• Support quality programs and company standards, performing additional duties as assigned.
• Travel as required.

Skills & Experience:

Qualifications That Will Help You Thrive

• Minimum of 3 years as a California indemnity examiner handling workers’ compensation claim; prior public entity experience is a plus.
• SIP certification preferred.
• Bachelor’s degree from an accredited college or university preferred.
• Proficient in regulations, offsets, disability duration, and medical management practices relevant to California workers' compensation claims.
• Strong oral and written communication skills, including presentation abilities.
• Proficient in Microsoft Office and other necessary software.
• Analytical, interpretive, and organizational skills with the ability to prioritize tasks.
• Good interpersonal skills and a team-oriented approach.
• Excellent negotiation skills and ability to meet service expectations.

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