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Role Description

Our client, a leading A-rated Workers' Compensation Insurance Company, is seeking an experienced Senior Workers’ Compensation Claims Representative to join their California team. The ideal candidate will have demonstrated experience handling moderate to complex California Workers’ Compensation lost time claims from inception through resolution.

• Manage 90 - 100 moderate to complex California Workers’ Compensation lost time and medical only claims with minimal supervision.
• Conduct timely and thorough investigations in compliance with California Labor Code and regulatory requirements.
• Coordinate and manage medical treatment in accordance with California Medical Treatment Utilization Schedule (MTUS) guidelines.
• Proactively influence early and safe return-to-work outcomes.
• Establish appropriate reserves and maintain accurate file documentation.
• Develop and execute litigation strategies in partnership with defense counsel.
• Negotiate settlements with injured workers and applicant attorneys.
• Present high-exposure or complex claims to management and/or committee as required.
• Maintain compliance with all California statutory deadlines and claims handling regulations.
• Deliver consistent, high-level customer service to clients, claimants, and internal stakeholders.
• Adhere to departmental Best Practices and regulatory standards.

Qualifications

• 5+ years of experience handling California Workers’ Compensation lost time claims
• Strong working knowledge of California Workers’ Compensation laws, Labor Code, and WCAB procedures
• Experience handling litigated claims through resolution
• Strong negotiation, analytical, and organizational skills
• Excellent written and verbal communication abilities
• High School Diploma required; Bachelor’s Degree preferred

Benefits

• $95,000 – $110,000 annual base salary plus bonus (Compensation may vary based on experience, qualifications, and geographic location)
• Competitive Medical, Dental, and Vision plans
• Generous PTO package
• Flexible work schedule with remote work flexibility (California-based candidates preferred)
• 401(k) with employer match
• Opportunity for career growth and advancement

Company Description