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Claims Adjuster III
Intercare Holdings Insurance Services. Perform three-point contact on all new losses .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive expertise in workers' compensation claims management, particularly in complex and high-exposure cases, while effectively leading litigation processes and maintaining strong client relationships. Proficient in mentoring junior adjusters and managing multi-party liability claims with a focus on strategic resolution and compliance.
Highest-signal resume keywords
Workers' Compensation Claims ManagementComplex Litigation DirectionPermanent Disability Rating ExpertiseClient Relationship ManagementCalifornia SIP Certificate
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Claims AdministrationIndemnity ManagementMulti-Party Liability InvestigationSubrogation RecoveryLife Care Planning CoordinationMedical Bill ReviewSettlement NegotiationReserve AdjustmentFraud Indicator IdentificationMediation and Arbitration Leadership
Soft Skills
MentoringProactive CommunicationStakeholder EngagementProblem SolvingTeam Collaboration
Tools & Technologies
Claims Processing PlatformsMicrosoft OfficeClaims Management Platforms
Certifications & Qualifications
CA SIP Certificate
Industry Keywords
Public Entity Liability ClaimsSelf-Insured ProgramsPooled Insurance ArrangementsCalifornia Workers' Compensation StatutesMulti-Jurisdiction Experience
About the role
Key responsibilities & impact- Perform three-point contact on all new losses
- Apply heightened scrutiny to complex, catastrophic, and high-exposure cases
- Maintain detailed action plans and strategic resolution plans for assigned indemnity files
- Identify fraud indicators and refer cases to SIU
- Investigate and document complex claims involving multi-party liability, catastrophic injury, subrogation, or novel legal issues
- Lead medical management, direct specialists, coordinate life care planners, direct UR and IMEs, and manage PTD cases
- Partner with case managers to maximize early return to work
- Review medical bills for high-cost and unusual treatment patterns
- Lead permanent disability ratings and establish or adjust reserves on high-exposure files
- Ensure status reports comply with client reporting timelines and formats
- Direct litigation, select defense counsel, set strategy, retain experts, manage legal spend, and prepare for trial
- Lead mediations, settlement conferences, and arbitrations
- Make or recommend high-value settlement authority decisions with the Claims Supervisor and client
- Negotiate and finalize high-value settlements, including C&R and Stipulated Awards
- Manage multi-lien resolution and coordinate with lien counsel and CMS
- Pursue subrogation, contribution, and apportionment recovery
- Serve as technical backup for the Claims Supervisor
- Guide complex decisions, reserve adequacy, and escalated client issues
- Mentor Adjuster I and II colleagues and support unit-wide quality review
- Serve as senior point of contact for key client accounts
- Maintain client and carrier relationships
- Communicate proactively and transparently with stakeholders
Requirements
What you’ll need- Minimum 7 years of workers’ compensation claims experience, including at least 5 years of independent indemnity management with expertise in complex, high-exposure, and litigated files; OR bachelor’s degree and a minimum of 5 years of workers’ compensation indemnity experience at an independent level; OR equivalent combination
- Comprehensive knowledge of public entity liability claims, including JPAs, self-insured programs, and pooled insurance arrangements
- CA SIP certificate required
- Deep expertise in applicable state workers’ compensation statutes; California statute mastery strongly preferred
- Multi-jurisdiction experience highly valued
- Direct experience with claims administration or claims processing platforms used in workers’ compensation/insurance claims handling
- Demonstrated experience directing complex litigation through mediation, settlement conference, and trial preparation
- Advanced knowledge of permanent disability rating, MSA requirements, and multi-party lien resolution
- Experience with catastrophic injury management and life care planning coordination
- Familiarity with claims management platforms
- Proficiency in Microsoft Office
- Demonstrated ability to mentor junior adjusters and serve as supervisory backup or senior technical resource
- Strong client relationship management skills and experience handling escalated concerns at a senior level
Benefits
Comp & perks- Strong training and expert support
- Reasonable caseloads
- Collaborative teams
- Career paths for professionals who want to grow or move into leadership
- Hybrid work arrangement
- Equal opportunity employment
- Reasonable accommodations for individuals with disabilities