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We are looking for a Senior Workers Compensation Adjuster who has significant experience working in California. This individual will handle the adjustment of workers compensation claims for our programs and captives. Their responsibilities include investigating, evaluating, and resolving these claims within their authority. This involves assessing compensability, medical and lost time claims, and establishing appropriate reserves in line with authority and Best Practices. The ideal candidate will possess demonstrated experience and be capable of independently managing complex workers’ compensation claims. They must conduct thorough investigations involving injured workers, insured individuals, medical providers, and witnesses. The candidate will oversee all aspects of the claims process to ensure accurate compensability assessment, reserve setting, and resolution. This will involve giving individual direction and utilizing vendors while adhering to company Best Practices,carrier guidelines and statutory requirements.

Your Impact:

  • Responsible for client relationship development and claim service satisfaction, leading to client retention and growth of the programs.
  • Oversee the handling of all aspects of the claims assigned within authority, including investigation, reserving, documentation, evaluation, medical management, negotiation, and settlement.
  • Experience and skills to manage complex litigation, compensability, and medical issues.
  • Work with clients and carrier partners in a team approach to achieve best possible outcomes within authority and reporting requirements.
  • Establish claim reserves based on most likely outcome of a claim with the known facts and investigation utilizing company standards and experience.
  • Utilize all available medical management tools and partners to ensure each injured worker attains best possible outcome through authorization of appropriate treatment plans and accurate billing.
  • Partner with internal and external legal counsel on litigated or questionable cases. Build strong relationships while ensuring sound legal plans are executed within jurisdictional requirements and financial accountability.
  • Proactively handle claims with consistent documentation and execution of agreed- upon action plans and strategy.
  • Demonstrate critical thinking and decision-making skills, to oversee, manage and direct claim processes in a fast-paced environment, while maintaining effective and professional relationships with all stakeholders.
  • Meet claim handling quality and service standards with timely reporting and presentation of claims to clients, carriers and reinsurers.

Successful Candidate Will Have:

  • Minimum experience of 8 years with ideal candidate having 10 or more years of experience in the management of workers’ compensation claims for the states required by the position.
  • Self-starter and the ability to work independently consistent with the required experience level, with little supervision and direction.
  • Thorough understanding of state laws, principles of compensability, medical and insurance industry in general.
  • Proven ability to build lasting inter-personal relationships and develop credibility with clients, brokers and carriers based on technical claim knowledge.
  • Strong claim investigative skills and the ability to present the findings and conclusions effectively to others both verbally and in writing.
  • Valid adjusters licensing, and experience in multiple states is a plus. Texas is preferred as the home licensing state, but not required.
  • Ideal candidates must have handled California claims and must have current California claims adjuster post-designation training form.

About One80:

One80 Intermediaries is a privately held firm with offices throughout the US and Canada. As a leading insurance wholesaler and program manager, One80 offers placement services and binding authority for property and casualty, life, travel/accident and health, affinity and administrative services, and warranty business. Launched just four years ago, One80 Intermediaries has grown to be one of the largest intermediaries in the United States. In 2022, Business Insurance ranked One80 as the 5th Largest MGA/Underwriting Manager/Lloyd’s Coverholder, and 5th Largest Underwriting Manager in the country.

Innovative Risk Management, a subsidiary of One80, is at the forefront in the development and management of alternative risk programs and is recognized as one of the top program managers in the country. Programs include captive insurance programs, self-insurance programs, risk retention groups and specialty insurance programs. IRM also provides unbundled loss control and claims administrative services for insurance companies, public entities, self-insured organizations, captives and specialty insurance programs. 

At One80 Intermediaries, base pay is one part of our total compensation package, which also includes a comprehensive suite of benefits, including medical, dental, vision, disability, life, and retirement savings. The total compensation for a position may also include other elements dependent on the position offered. The expected base hourly/annual pay range for this position is between $80,000 - $95,000 plus discretionary bonus. The actual base pay offered may vary depending on multiple individualized factors, including geographical location, education, job-related knowledge, skills, and experience.

One80 Intermediaries is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics.

Learn more about working at One80 Intermediaries by visiting our careers page: www.one80.com/careers.

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Confirmed 7 hours ago. Posted 30+ days ago.

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