Department:
ClaimsJob Description:
As a Senior Workers’ Compensation Adjuster, you will be responsible for managing moderate to complex workers’ compensation claims from initial investigation through resolution. Key responsibilities include conducting interviews with insured parties, claimants, witnesses, and other relevant individuals to assess claim eligibility; obtaining statements; analyzing coverage; determining compensability and applicable benefits; setting appropriate reserves; negotiating settlements; and litigation management.
The role carries settlement authority up to $175,000 and involves handling a broad
range of claims.
This is a remote position requiring minimal supervision. The ideal candidate will be well-versed in standard claims practices and procedures and will rely on professional judgment and experience to achieve objectives. The role demands versatility, problem-solving skills, strong organizational skills, self-direction, and the ability to manage competing priorities independently. Additionally, the adjuster may provide mentorship or support to junior team members in their claims handling.
Work Arrangement:
Employees who live within 30 miles of the TMG home office are expected to follow a hybrid or in-office schedule. The initial training period may require additional in‑office days.
Accountabilities:
Investigate coverage and determine compensability in accordance with California workers’ compensation laws
Establish and maintain appropriate reserves
Manage indemnity and litigated claims including exposure analysis and settlement strategy, in compliance with California Regulations.
Collaborate with defense counsel to evaluate exposure and drive claims toward timely and equitable resolution
Maintain timely and accurate claim file documentation in accordance with company protocols
Coordinate medical management, including UR/IMR and return-to-work strategies
Prepare clear and professional written communications and reports
Participate in claim reviews and case discussions
Maintain diary system in accordance with company standards
Coordinate medical management, including UR/IMR and return-to-work strategies
Identify and address claims with Medicare exposure
Identify and pursue subrogation opportunities
Recognize potential fraud indicators (red flags) and refer cases to SIU as appropriate
Assign and oversee vendor resources, ensuring quality and timeliness of services
Communicate effectively with internal and external stakeholders and provide mentorship to junior staff
Qualifications:
5+ years California workers’ compensation claims experience
Current Experienced Adjuster Designation
Bachelor’s degree preferred
Experience adjusting complex indemnity and litigated claims
Core Skills:
Advanced knowledge of California workers’ compensation regulations and laws
Ability to work independently and efficiently in a remote environment
Excellent analytical and problem-solving abilities
Effective verbal and written communication skills
Ability to negotiate skillfully in challenging situations.
Strong organizational and time management skills with ability to prioritize competing demands
Proficiency with Microsoft Word, Excel, and Outlook
Ability to perform advanced mathematical calculations
Pay Range:
Anticipated Hiring Range:
$79,500 - $110,000 annual base salary depending on experience, qualifications, and geographic location
Benefits:
We are proud to offer our full-time regular employees a robust benefits suite that includes:
Competitive base salary plus incentive plans for eligible team members
401(K) retirement plan that includes a company match of up to 6% of your eligible salary
Free basic life and AD&D, long-term disability and short-term disability insurance
Medical, dental and vision plans to meet your unique healthcare needs
Wellness incentives
Generous time off program that includes personal, holiday and volunteer paid time off
Flexible work schedules and hybrid/remote options for eligible positions
Educational assistance
Equal Opportunity Employer
The Mutual Group is an Equal Opportunity Employer. It is our policy to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact
Talent@themutualgroup.com
.Employment Verification
The Mutual Group participates in the E-Verify program and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. You are protected from employment discrimination based on your citizenship status and national origin.
All offers of employment are contingent upon the successful completion of a background check.
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