Job Description

Overview:

TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide.

Job Title: Sr Adjuster WC - CA.

Work Location: Roseville, CA 95661

Job Type: Full time

Work Type: Onsite

Duration: Full time

Job Description:

POSITION OVERVIEW:

• The Senior Workers Compensation Adjuster is responsible for managing moderate to complex and high-value casualty claims with minimal supervision.
• This role requires advanced investigative and negotiation skills to effectively resolve disputes and handle escalated situations.
• The Consultant works closely with internal and external experts, including legal counsel and technical specialists, to ensure thorough claim evaluation and resolution.

Key responsibilities:

• Include representing the company in various forums related to claims litigation, maintaining a high standard of professionalism, and ensuring compliance with regulatory and company standards.
• The role demands strategic thinking, sound judgment, and the ability to navigate sensitive and high-impact claim scenarios.

IN THIS ROLE, YOU WILL:

• Independently manage moderate to complex, high-value casualty claims, ensuring thorough analysis and resolution.
• Lead thorough investigations, assess coverage, and issue appropriate documentation including reservation of rights and coverage letters. Escalate issues as needed.
• Identify opportunities to transfer risk and pursue subrogation.
• Proactively resolve disputes, deescalate sensitive situations, and ensure optimal claim outcomes through strategic negotiation and litigation management.
• Ensure all claims activities comply with regulatory and company standards.
• Maintain accurate, detailed records and prepare comprehensive reports.
• Execute jurisdictional compliance requirements and support others in understanding regulatory obligations.
• Set reserves, authorize payments, and make financial decisions within authority.
• Demonstrate strong financial acumen and contribute to reserving accuracy and efficiency.
• Coordinate with internal and external stakeholders including legal, underwriting, vendors, and agents. Lead cross-functional meetings and communicate complex information clearly to diverse audiences.
• Use advanced tools and analytics to identify trends, correct inconsistencies, and improve claims handling efficiency.
• Ensure proper data ingestion, labeling, and protection of personally identifiable information (PII).
• Serve as a mentor to junior claim handlers, providing guidance on complex claims, compliance, and litigation processes.
• Support training initiatives and contribute to the development of best practices and educational materials.

WHAT YOU NEED TO APPLY:

• Bachelor's degree preferred, or a combination of education and equivalent experience.
• 5 10+ years of workers compensation claims handling experience with an insurance carrier.
• Must possess or obtain and maintain appropriate state adjuster licenses and continuing education credits.
• Skilled in negotiating complex claims and developing strategies to influence outcomes.
• Demonstrates sound judgment and decision-making on high-exposure cases, including litigation and compliance matters.
• Communicates clearly and effectively in both verbal and written formats across a variety of situations.
• Selects appropriate communication channels and consistently demonstrates empathy toward all stakeholders.
• Highly organized with the ability to manage complex workflows and participate in project work. Demonstrates strong time management and desk management skills, and mentors others in these areas.
• Possesses in-depth understanding of the regulatory environment and jurisdictional requirements. Handles complex compliance issues and mentors others on regulatory standards.
• Provides exceptional, empathetic customer service. Effectively manages escalated claims and sensitive customer concerns with professionalism and clarity.
• Ability to use a personal computer and other standard office equipment.
• Ability to sit and/or stand for extended periods.
• Required to work on-site as needed.
• Ability to travel as necessary.
• Ability to work in a fast paced, changing or stressful environment.
• Ability to perform work in a noisy/loud work environment.
• May be required to have and maintain sufficient home-based internet connection.

TekWissen Group is an equal opportunity employer supporting workforce diversity.

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