Senior Workers Compensation Claims Adjuster

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🔥 4 hours ago

🏄 California – Remote

🏄 California – Remote

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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Dayforce

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

👥 HR Tech

☁️ SaaS

🏢 Enterprise

💰 $1G Post-IPO Debt - Dayforce on 2024-03

HR Tech • SaaS • Enterprise

Dayforce is a cloud-based human capital management (HCM) and workforce management platform (offered by Ceridian). Dayforce provides a unified SaaS application that combines payroll, HR, benefits administration, time and attendance, workforce scheduling, and talent management to help employers manage employees, payroll, and compliance workflows. It is primarily sold to businesses and enterprises as an HR/payroll workforce solution.

📋 Description

• 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. • Deliver empathetic, clear communication throughout the claims process. • Educate claimants and stakeholders, affirm next steps, and ensure a positive customer experience. • Attend industry events and continuing education seminars to stay current with best practices, legal developments, and emerging trends.

🎯 Requirements

• Bachelor’s degree preferred, or a combination of education and equivalent experience. • Typically requires 5–10 years of claims handling experience. • 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. • Maintains comprehensive and organized claim records and prepares detailed reports summarizing findings and recommendations. • 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. • Makes informed decisions based on thorough analysis of complex issues. • Evaluates risks and outcomes, acts independently within authority, and identifies patterns in claims to support resolution strategies. • Highly skilled in investigating complex cases and collaborating with internal and external experts. • Possesses in-depth understanding of the regulatory environment and jurisdictional requirements. • Provides exceptional, empathetic customer service.