Claims Adjuster

Intercare Holdings Insurance Services

. Manage all aspects of workers compensation claims throughout the claim lifespan .

Posted 11/10/2026full-timeRemote • California • United StatesSeniorLead💰 $110,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Expertise in managing Workers Compensation Claims, including determining compensability, administering benefits, and negotiating resolutions. Proficient in medical terminology and California workers compensation laws, with strong communication and organizational skills.

Highest-signal resume keywords

10 Years Experience Adjusting Workers Compensation ClaimsSIP CertificationBilingual (Spanish/English)Proficiency In Microsoft Office SuiteKnowledge Of Workers Compensation Laws

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ManagementCompensability DeterminationDisability Benefits AdministrationMedical TerminologyNegotiation SkillsClaims DocumentationLost-Time Wage CalculationSubrogation RecoveryMedical Bill ReviewReturn-To-Work Collaboration

Soft Skills

Excellent Oral CommunicationExcellent Written CommunicationAttention To DetailGood Organization SkillsCustomer Service Focus

Tools & Technologies

Electronic DatabaseThird-Party Vendor SystemsMicrosoft Office Suite

Certifications & Qualifications

SIP CertificationCurrent CEUs

Industry Keywords

Workers CompensationCalifornia Workers Compensation LawsMedical CasesClaim ValidityInsurance Claims

About the role

Key responsibilities & impact

Manage all aspects of workers compensation claims throughout the claim lifespan
Determine compensability and verify coverage
Administer disability and medical benefits
Negotiate claim resolutions and assist injured employees, employers, and medical/legal professionals
Receive newly reported claims and maintain updated claim notes
Record claim information in an electronic database
Interview claimants, insureds, medical professionals, and witnesses to determine claim validity
Communicate claim compensability decisions to claimants, employers, and medical providers
Set appropriate reserves based on the nature and extent of injuries
Calculate lost-time wages, make disability payments, and diary future payments
Order independent medical examinations and prepare documentation for physician review
Correspond regularly with claimants, insureds, and nurse case managers regarding claim updates, appointments, and disability-payment issues
Review and process medical bills through a third-party vendor for discount opportunities
Collaborate with claimants and insureds to pursue early return-to-work
Partner with legal counsel on litigated claims and provide documentation for defense and exposure evaluation
Attend settlement conferences, mediations, and hearings on behalf of the insurance company or insured
Review and approve defense attorney bills within authority
Work with underwriting on loss information for renewal rates and with Risk Management to identify trends
Interact with insureds' agents regarding losses as needed
Respond to state requests for health-cost disputes, hearing applications, and penalty assessment letters
Identify subrogation potential and pursue recovery
Lead claim reviews with clients as requested
Perform other duties as assigned

Requirements

What you’ll need

10 years of experience adjusting Workers Compensation Claims in California required
SIP Certification required
Bilingual (Spanish/English) required
Must be current with CEU's
Proficiency in entire Microsoft Office suite
Knowledge of relevant workers compensation laws
Strong grasp of medical terminology
Familiarity with medical cases and how treatment typically progresses
Excellent oral and written communication abilities
Attention to detail and good organization skills
Ability to negotiate issues and settlements
Strong focus on customer service, including timely response to requests/inquiries
Ability to adapt to changing technologies and learn functionality of new equipment and systems
Ability to establish and maintain effective working relationships with others