Claims Adjuster III

About the Role

This position sits within a specialty risk management organization that supports self-insured employers across multiple states. The environment is built around manageable caseloads, strong internal training, teamwork, and operational support, with an emphasis on helping claims professionals build long-term careers and move into leadership when ready.

Role Summary

The Claims Adjuster III reports to the Claims Supervisor and may provide technical backup when the supervisor is unavailable. The role is responsible for taking assigned claim files through to resolution, including matters that may be highly complex or involve unusual circumstances, while staying aligned with statutory requirements, company procedures, and performance goals.

Key Responsibilities

• Contact the claimant, employer, and treating physician within 24 hours of receiving a new loss to gather the initial facts, confirm disability status, and document treatment details.
• Maintain clear, complete claim notes and record the information needed to determine compensability, disability benefits, vendor involvement, medical payments, expense payments, and progress toward closure.
• Keep every indemnity claim supported by an active action plan that outlines the steps expected to resolve the file.
• Work closely with the medical case manager to support early return-to-work outcomes and help limit extended disability and vocational rehabilitation costs.
• Send suspected fraud matters to SIU for review and follow-up.
• Pursue subrogation, contribution, and apportionment opportunities where third-party fault, multiple defendants, or pre-existing disability may affect recovery.
• Ensure claim handling remains compliant with applicable statutes, service contracts, and internal guidelines.
• Review and approve vocational rehabilitation plans.
• Set, monitor, and revise financial reserves within approved authority limits when circumstances require it.
• Check medical bills for appropriateness before forwarding them to InterMed for payment and file posting.
• Represent the company professionally and maintain a courteous, service-oriented approach in all interactions.
• Return phone messages and inquiries within 24 hours and written inquiries within one week.
• Apply working knowledge of California workers’ compensation law and related claim-handling requirements.
• Lead and control litigation activity as needed.
• Complete other tasks assigned by the supervisor or manager.

Competencies

• Uses sound judgment to identify issues quickly, assess information, and develop practical solutions.
• Handles difficult customer interactions with professionalism, responsiveness, and follow-through.
• Communicates respectfully, protects confidentiality, manages conflict constructively, and stays open to others’ ideas.
• Contributes to team success and works collaboratively toward shared goals.

Experience and Qualification Requirements

A bachelor’s degree from a four-year college or university is required, along with at least seven years of related experience or training, or an equivalent mix of education and experience. The role also calls for deep claims expertise, including a minimum of five years handling indemnity claims with complex or high-potential subrogation, rehabilitation, medical management, and/or legal issues. An SIP certificate is required.

Benefits

The company offers a people-first benefits package designed to support health, financial wellbeing, and career development.

• Medical, dental, and vision coverage
• Company contributions to HSA and FSA plans
• Employer-paid life and disability insurance
• 401(k) plan with company match
• Paid time off and company holidays
• Learning and development programs focused on career growth
• Employee assistance resources and a culture that supports balance and wellbeing

Additional Information

This employer is an equal opportunity employer and considers all applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. In addition, qualified applicants with arrest or conviction records will be considered in accordance with the Los Angeles and San Francisco Fair Chance Ordinance.

Salary is described as an estimate only, and actual pay will depend on factors such as experience, qualifications, skill set, and work location.