Senior Claims Adjuster

About the role

Senior Claims Professional Opportunity

Bhhc presents an immediate opening for Senior Claims Professionals. The organization seeks individuals who operate effectively with minimal oversight. Candidates must deliver measurable results and embrace ownership for their contributions. This role is designated as Exempt. The base compensation is listed at sixty-nine thousand one hundred thirty-five dollars annually. The position is located in Sacramento, California.

Position Overview

The appointed individual will manage a portfolio of intricate workers compensation indemnity claims. The scope extends from initial reporting through final resolution. Professionals in this role function with general supervision. They operate within elevated reserve and settlement parameters. Active participation in special initiatives aimed at enhancing operational efficiency is expected. The goal is to refine existing departmental processes.

This position replaces the prior Senior Claims Adjuster designation. The focus remains on complex case management. Successful applicants will contribute to systemic improvements. They will help define how work progresses through the organizational structure.

Key Responsibilities

Staff will design structured intake procedures. These steps clarify claim specifics and identify obstacles prior to active work. The analysis ensures all necessary documentation is present from the outset.

The development of reserves and settlement strategies is a core function. Professionals will utilize established parameters alongside independent judgment. Every complex case requires a distinct financial and strategic approach. Decisions must align with both regulatory compliance and organizational objectives.

Ongoing examination of claim status is mandatory. This ensures strict adherence to governing rules and guidelines. Staff must verify alignment with broader corporate goals. Consistent oversight guarantees that cases progress appropriately.

Collaboration with defense partners is essential. This coordination seeks to align strategic perspectives. The objective is to secure timely and informed decisions. Joint efforts aim to resolve matters efficiently and effectively.

Staff are responsible for delivering final resolutions. They must satisfy all specified conditions to close cases. Structured review routines facilitate thorough case completion. This process ensures nothing is overlooked.

Participation in team projects is required. These projects target the removal of redundant tasks. The focus is on improving current workflows and methodologies. Identifying inefficiencies leads to sustainable improvements.

Mentorship of junior personnel is a key duty. Senior staff will guide new hires through difficult files. They will instill methods for maintaining consistent quality. Knowledge transfer is vital for team stability.

Tracking outcomes for complex claims is necessary. This ensures that established methods remain effective over time. Data analysis informs future strategic adjustments. Professionals must review metrics regularly.

Required Qualifications

Applicants must possess three years of experience. This experience must involve complex workers compensation claims. The background should be specific to this functional role.

The ability to work independently is non-negotiable. Professionals must maintain high standards without constant direction. Self-discipline and personal accountability are essential traits.

Full responsibility for decisions and their consequences must be accepted. This includes ownership of both successes and setbacks. Judgment and discretion are critical components.

A clear understanding of numeric reserves is required. Candidates must know how these figures affect case strategy. Closure decisions depend on this financial acumen.

Knowledge of specific claim types is mandatory. This includes body parts and scheduled injuries. Familiarity with corresponding state rules is necessary. Proper application of regulations is expected.

The ability to manage medical records is essential. Professionals must handle treatment details autonomously. Meticulous organization ensures accurate case progression.

Clear communication skills are required in all formats. Professionals must interact effectively with teams and partners. Both spoken and written expression must be precise.

Proficiency with claim systems is necessary. Staff will update status and record decisions. They will maintain organized digital files. Technical aptitude supports daily operations.

Preferred Qualifications

Experience with California-based employers is advantageous. This includes insurance carriers operating in the local market. Familiarity with regional practices provides a strategic edge.

Competencies and Tools

The role centers on Workers Compensation expertise. Key areas include analysis of Body Parts. Claim Systems proficiency is required. Reserve Development is a primary function. Mastery of Settlement Parameters is essential.

What you'll do

• Meet the bar Practical notes