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This is an on-site, full-time temporary role. The Senior Workers’ Compensation Claim Representative will be responsible for managing all aspects of lost time claims for California, ensuring superior customer service and compliance with state regulations. As a Senior Workers’ Compensation Claim Representative, you’ll work closely with attorneys, vendors, and internal teams to deliver high-quality claims management services.
Job Responsibility:
Manage workers' compensation lost time claims from start to closure
Conduct comprehensive investigations and evaluate compensability
Communicate claim decisions to insureds, claimants, and attorneys
Administer statutory medical and indemnity benefits throughout claim lifecycle
Set and adjust reserves within authority limits
Collaborate with attorneys on hearings and litigation strategies
Direct nurse case managers, rehabilitation vendors, and telephonic case managers
Ensure compliance with all statutory filing requirements
Pursue subrogation opportunities where applicable
Maintain detailed file notes and participate in claim reviews
Requirements:
Certification to handle California Workers’ Compensation claims is required
Minimum experience in lost time claims handling or similar fields (healthcare, disability, auto injury, etc.)
Working knowledge of California workers' compensation statutes and compliance regulations
Proficiency in Microsoft Office and familiarity with medical terminology and bill processing
Ability to analyze data and incorporate insights into claim resolution
Strong written and verbal communication skills
Must obtain applicable resident/designated home state adjuster license if not already held
Nice to have:
Preferred experience handling claims in CO, UT, NV, and AZ
AIC, RMA, or CPCU coursework/designations are a plus
What we offer:
medical, vision, dental, and life and disability insurance