Job Description

CLAIMS ADJUSTER - WORKERS' COMPENSATION We are JT2, a successful statewide third party administrator (TPA). We have a career opportunity for a Workers' Compensation Claims Adjuster, available in our Northern California branch located in Oakland. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration with risk control solutions. We expertly handle the entire claims process with proactive communication and responsive reporting that builds relationships with all stakeholders, mitigating risk and containing cost. With over two decades of experience in claims administration, JT2 has delivered consistent cost savings to clients while providing quality care to claimants. Our excellence in this sector has been recognized by regulating bodies and clients alike. Our expertise ranges from public to private clients with specialization in JPA's, municipalities, and school districts. JT2 is proud to be the largest Hispanic-owned TPA in the United States with a diverse workforce that is committed to strengthening the communities we serve. 65% of our employees identify as “minority”: 29% African American, 21% Asian, 15% Latino, and our staff consistently volunteer over 400 hours annually to business and community organizations supporting the underserved. CLAIMS ADJUSTER JOB DESCRIPTION You adhere to best practices and State of California statutes to work directly with clients, injured workers, agents, vendors, and attorneys to resolve workers compensation claims.

• You use best practices for claims handling, investigate, evaluate, reserve, process and resolve assigned claims per client service agreements and JT2 service standards.
• You manage claims from inception to conclusion.
• You prepare accurate and timely issuance of benefits notices and required reports within statutory limits.
• You reserve files in compliance with injury type; identify potential costs of medical care investigation and indemnity .benefits.
• You ensure timely payment of benefits, bills and appropriate caseload and performance goals.
• You negotiate and prepare claims for settlement; provide manager/supervisor with complete and accurate settlement data.
• You monitor, report, and assign claims for fraud potential and subrogation possibilities.
• You monitor claims for pre-established criteria for case-management and vocational rehabilitation in accordance with State laws.
• You train and direct Claims Assistants to meet goals and deadlines.
• You review and approve priority payments and other documents from Claims Assistants.
• You prepare and present claims summaries to clients during file reviews.

CLAIMS ADJUSTER QUALIFICATIONS

• You have a current Self-Insurance Plan (SIP) Certificate and insurance-related course work: CPCU, WCCA, WCCP, ARM.
• You are experienced in adjusting workers' compensation claims for municipalities and administering LC 4850 benefits.
• You are knowledgeable of workers' compensation policy; concepts and terminology; benefit provisions; compensability; notice requirements; cumulative trauma; WCAB procedures and terms; investigation; fraud; medical terms; fee schedules; liens; apportionment; subrogation; reserving and ethical issues.
• You’re PC literate including Microsoft Office products.
• You’re able to handle multiple tasks in a dynamic work environment.
• You have the ability to work in a team environment, good interpersonal skills.
• You are able to achieve high performance standards and exceed service expectations.

JT2 BENEFITS (AFTER 30 DAYS OF EMPLOYMENT) At JT2, we know that our greatest asset is our people. We strive to empower our employees to take on rewarding challenges, focus on client solutions and be drivers of innovation as our industry evolves. We consider our employees family and not only embrace diversity, but seek it out in all forms.

• We offer a medical, dental, and vision package.
• We match on your 401k retirement plan.
• Our employees enjoy company paid and voluntary life insurance.
• We have health and dependent care spending accounts.
• Our employees earn PTO at 10 PTO days per year, which start accruing after 90 days.
• In addition, JT2 recognizes 9 holidays during the calendar year.
• JT2 offers career development and mentorship, on-site industry classes, and webinars.

Be the next all-star on our team of expert and apply today! We are an equal opportunity employer and value diversity in our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.