Workers' Compensation Claims Examiner III - Salinas, CA (Contract - FULL REMOTE) Workers' Compensation Claims Examiner III - Salinas, CA (Contract - REMOTE)
Pay Rate: 55.55 Location: Salinas, CA - REMOTERole Summary
As a Workers' Compensation Claims Adjuster III you are a senior technical expert trusted with our clients most complex, high-exposure, and strategically sensitive claims—including catastrophic injuries, multi-party litigation, and cases with novel legal or medical challenges. You provide technical guidance and supervisory backup to your unit and serve as a senior resource for clients, carriers, and colleagues.
Essential Duties & Responsibilities
Complex Claims Investigation & Compensability:
Perform three-point contact on all new losses and apply heightened scrutiny to complex, catastrophic, and high-exposure cases; maintain detailed plans of action with strategic resolution planning on all assigned indemnity files. Identify fraud indicators and refer to SIU with advanced pattern recognition; gather and document case facts on files involving multi-party liability, catastrophic injury, significant subrogation potential, or novel legal issues.
Medical Management, RTW & Vocational Rehabilitation:
Lead medical management on catastrophic and high-complexity claims including directing specialists, coordinating life care planners, directing UR and IMEs, and managing PTD cases. Partner with case managers to maximize early RTW; review medical bills for appropriateness on high-cost and unusual treatment patterns.
Permanent Disability, Reserving & Financial Stewardship:
Lead PD rating on complex cases including significant apportionment, overlapping injuries, and disputed ratings; establish and adjust reserves on high-exposure files with precision and clear documented justification. Ensure status reports are submitted in compliance with the reporting timelines and formats outlined in individual client instructions.
Litigation Management:
Independently direct the full litigation process on the unit's most complex files including selecting defense counsel, setting strategy, retaining experts, managing legal spend, and preparing for trial. Lead mediations, settlement conferences, and arbitrations; make or recommend high-value settlement authority decisions in coordination with the Claims Supervisor and client.
Settlements, Lien Resolution & Recovery:
Independently negotiate and finalize high-value settlements including C&R and Stipulated Awards; manage multi-lien resolution (MSA, Medi-Cal, provider, attorney liens) and coordinate with lien counsel and CMS as required. Aggressively pursue subrogation, multi-defendant contribution, and apportionment recovery; coordinate with recovery vendors and outside subrogation counsel on high-value opportunities. Technical Leadership & Supervisory BackupServe as technical backup for the Claims Supervisor; provide guidance on complex decisions, reserve adequacy, and escalated client issues; mentor Adjuster I and II colleagues and support unit-wide quality review. Serve as a senior point of contact for key client accounts on complex or escalated matters; maintain client and carrier relationships with professionalism and technical authority.
Professionalism & Communication:
Maintain proactive, transparent communication with all stakeholders; respond within required timeframes and project a professional, expert image in all interactions.
Qualifications
Education & Experience:
Minimum 7 years of WC 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 WC 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.
Licenses & Certifications:
Active adjuster license in applicable state(s) required; multi-state preferred. CA SIP certificate required for CA files. (CA only) Professional designations such as AIC, ARM, WCCP, or CPCU a plus but not required.
Technical & Subject Matter Expertise:
Deep expertise in applicable state WC statutes; California statute mastery strongly preferred. Multi-jurisdiction experience highly valued. Direct experience working within one or more claims administration or claims processing platforms commonly used in worker's compensation/insurance claims handling. Demonstrated experience directing complex litigation through mediation, settlement conference, and trial preparation; advanced knowledge of PD 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.
Leadership & Interpersonal Skills:
Demonstrated ability to mentor junior adjusters and serve as a supervisory backup or senior technical resource.
Strong client relationship management skills; experience handling escalated concerns at a senior level.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Johnson Service Group (JSG) offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.
