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California Workers Compensation Defense Adjuster

TPI (Tech Providers, Inc.)

  • 1 day ago
  • Remote
  • $90,000–$99,000 Per Year
  • Full-time

Highlights

The Senior Adjuster will work closely with legal counsel, underwriting, agents, vendors, and other internal and external stakeholders to achieve timely, accurate, and cost-effective claim resolutions. The ideal candidate will have strong expertise in claims investigation, coverage analysis, reserving, negotiation, litigation management, regulatory compliance, and customer service.

Numbers & Facts

Location (
Remote)
Job TypeFull-time
IndustryStaffing/Employment Agencies
Salary$90,000–$99,000 Per Year
Year Founded1998
HeadquartersBirmingham, Alabama, US
Websitehttp://www.techproviders.com/

Description

  • We are seeking an experienced Senior Workers’ Compensation Adjuster to join our California Lost Time Claims team. This role is responsible for independently managing moderate to complex, high-value workers’ compensation claims with minimal supervision.
  • The ideal candidate will have strong expertise in claims investigation, coverage analysis, reserving, negotiation, litigation management, regulatory compliance, and customer service. The Senior Adjuster will work closely with legal counsel, underwriting, agents, vendors, and other internal and external stakeholders to achieve timely, accurate, and cost-effective claim resolutions.
  • This position also serves as a resource and mentor to junior claims professionals and contributes to continuous improvement and best practices within the claims organization.

Job Responsibilities

  • Independently manage moderate to complex and high-exposure workers’ compensation claims from investigation through resolution.
  • Conduct comprehensive claim investigations, evaluate coverage, determine liability, and issue appropriate documentation, including reservation of rights and coverage letters.
  • Develop and execute claim strategies to resolve disputed and high-impact claims through effective negotiation and litigation management.
  • Identify opportunities for subrogation and risk transfer to optimize claim outcomes and reduce financial exposure.
  • Manage escalated and sensitive claims while maintaining professionalism, empathy, and a strong customer-service focus.
  • Establish and adjust claim reserves, authorize payments, and make financial decisions within assigned authority.
  • Maintain accurate claim files, documentation, reports, and financial records in accordance with company and regulatory requirements.
  • Ensure compliance with California workers’ compensation regulations, jurisdictional requirements, company policies, and applicable claims-handling standards.
  • Represent the company in various forums related to claims, including litigation, hearings, mediations, and other proceedings as required.
  • Partner with legal counsel, underwriting, agents, vendors, medical professionals, and other stakeholders to evaluate and resolve complex claims.
  • Lead cross-functional discussions and communicate complex claim information clearly to both technical and non-technical audiences.
  • Utilize claims technology, analytics, and reporting tools to identify trends, resolve data inconsistencies, and improve claims-handling efficiency.
  • Ensure appropriate handling, labeling, ingestion, and protection of personally identifiable information (PII).
  • Mentor and provide technical guidance to junior claims professionals on complex claims, compliance, litigation, reserving, and desk-management practices.
  • Support training programs, process improvements, and development of claims best practices and educational materials.
  • Escalate significant coverage, compliance, financial, litigation, and operational issues appropriately.

Qualifications

  • 5–10+ years of workers’ compensation claims handling experience, preferably with an direct insurance carrier.
  • Strong experience handling lost-time, moderate-to-complex, high-value/high-exposure workers’ compensation claims.
  • Bachelor’s degree preferred, or equivalent combination of education and relevant experience.
  • Appropriate California adjuster license or ability to obtain and maintain required licensing.
  • Ability to maintain required continuing education (CE) credits and licensing requirements.
  • Strong knowledge of workers’ compensation claims practices, regulatory requirements, and jurisdictional guidelines.
  • Proven experience with claim investigation, coverage analysis, reserving, negotiation, litigation, and settlement.
  • Strong financial judgment and ability to make reserving and payment decisions within assigned authority.
  • Excellent verbal and written communication skills with the ability to work effectively with diverse stakeholders.
  • Strong organizational, time-management, and claims desk-management skills.
  • Demonstrated ability to exercise sound judgment and make strategic decisions on high-exposure and sensitive claims.
  • Strong negotiation, conflict-resolution, and de-escalation skills.
  • Ability to mentor and provide guidance to less-experienced claims professionals.
  • Strong customer-service skills with an empathetic and professional approach.

Benefits

Paid Time-Off, Life Insurance, Work From Home, 401K

About Company

TPI started in 1998, providing technical professionals to businesses scrambling to fix the Y2K bug. We met those challenges head-on and established ourselves as an IT talent and services firm that could be counted upon.

Since then we’ve grown. We continue to connect employers with tough-to-find IT expertise and help technical professionals find jobs that match their career goals. Now we are doing the same with engineering, finance and accounting professionals from our Birmingham, Atlanta and Charlotte offices.

As one of the top engineering and IT recruiting firms in the country, we know what it takes to find the right people for the job. Building a talent network from professionals nationwide – people with tons of skills and experience in information technology, engineering, accounting & finance and more.

It’s hard to tell what a job will be like from a few words in an online job posting. Speak with a TPI recruiter to discuss your career goals. TPI provides the data – about the position and the corporate culture of our employers – so you can make intelligent career decisions. TPI has recruiting professionals dedicated to your success.

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