Worker's Compensation Claims Specialist
Location: Remote (California-based)
Position Overview
We are currently seeking an experienced Senior Claims Specialist with dedicated focus on California Workers Compensation claims. This fully remote role requires a self-directed professional who can independently manage a complex caseload from intake through resolution while maintaining high standards of accuracy, compliance, and customer service.
Responsibilities
Manage the full lifecycle of California Workers Compensation claims, including intake, investigation, compensability determination, reserving, and closure
Handle Lost Time and litigated files end-to-end, including coordination with defense counsel, applicants attorneys, and medical providers
Conduct thorough medical and legal analysis, evaluating treatment plans, work restrictions, disability status, apportionment, and claim exposure
Establish and maintain accurate reserves consistent with claim development and statutory requirements
Develop and document clear action plans outlining claim strategy, next steps, and resolution pathways
Draft detailed, well-reasoned claims reports and narrative documentation supporting decisions and recommendations
Ensure timely and accurate payment of indemnity, medical benefits, and settlements in compliance with California regulations
Monitor compliance with statutory deadlines, utilization review timelines, and litigation milestones
Negotiate settlements within assigned authority and participate in mediation, hearings, or settlement conferences as needed
Maintain frequent communication with injured workers, employers, attorneys, and internal stakeholders to manage expectations and resolve issues
Identify opportunities to reduce claim exposure and promote early resolution while maintaining regulatory compliance
Independently manage a high-complexity caseload in a remote setting with minimal supervision
Required Qualifications
510+ years of Workers Compensation claims experience, with a strong focus on California claims
Demonstrated success managing Lost Time and litigated claims from start to finish
Advanced knowledge of California WC laws, medical management, and legal processes
Strong written communication skills with the ability to produce clear, defensible reports and action plans
Ability to work autonomously and effectively in a remote environment
Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.
Pay Details: $35.00 to $45.00 per hour
Search managed by: Savannah Mckillip
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer/Veterans/Disabled
Military connected talent encouraged to apply
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The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.