This position is on-site in Martinez and requires a local candidate.
Schedule:
Monday – Friday 8:00 am to 5:00 pm.
Location: On-site in Martinez, CA (Remote after training)
Requirements:
- Certification: Must be a current Certified Claims Adjuster in the State of California pursuant to Title 10 of CCR2592 or possess the Self-Insurance Certificate issued by the State of California.
- Education: Completion of 60 semester or 90 quarter units from an accredited college or university, including at least six semester or nine quarter units in business, public administration, insurance, physical science, finance, or a closely related field.
- Substitution: Additional experience may be substituted for education on a year-for-year basis, up to two (2) years.
- Experience: Minimum of three (3) years of full-time work as a Workers' Compensation Claims Adjuster I or in an equivalent role with an insurance carrier or third-party claims administrator focused on workers' compensation indemnity claims.
Knowledge, Skills, and Abilities:
- Strong understanding of Workers' Compensation insurance principles, legal statutes, and civil procedures.
- Familiarity with medical and legal terminology, Medicare Set-asides, and the Americans with Disabilities Act (ADA).
- Ability to interpret legal statutes, analyze evidence, prioritize claims, and calculate benefits accurately.
- Experience in maintaining effective working relationships with stakeholders (employers, physicians, attorneys, etc.).
- Skilled in preparing clear, concise reports and oral presentations.
- Proficient in documenting work using Workers' Compensation Claims software and managing electronic claim files.
Typical Tasks:
Investigating and adjusting job-related injury claims, making determinations regarding compensability, medical treatment, disability compensation, and death benefits.
Interviewing claimants, witnesses, supervisors, and physicians to assess claim credibility.
Assisting legal counsel in case development, settlement negotiations, and Workers' Compensation Appeals Board representation when necessary.
Preparing reports, correspondence, and maintaining accurate claim files.
Managing referrals to ADA Coordinators and monitoring alternative work programs.
Collaborating with external vendors for utilization review and handling excess insurance cases.
EEO/AA Employer/Vet/Disabled.
The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf
The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.
AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf
We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records. For Los Angeles, CA applicants:
Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
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