Workers’ Compensation Claim Specialist

Own California Claims. Drive Compliance. Deliver Results!

Workers’ Compensation Claims Specialist

Location Remote-US (Reporting to Scottsdale, AZ) | Remote

COMPENSATION & SCHEDULE

• $85,000–$96,000 annually (depending on experience)

• Monday–Friday, 8:00 AM–4:30 PM MST

• Full-Time, W2

• Start date: TBD

ROLE IMPACT

The Workers’ Compensation Claims Specialist manages California jurisdiction claims for PEO accounts, ensuring accurate, compliant, and timely claim resolution. This position owns files from intake through closure, balancing regulatory adherence with strong client and claimant communication. Success is measured by audit results, reserving accuracy, timely settlements, and high service standards.

• Key Responsibilities

• Manage full-cycle California workers’ compensation claims, including investigation, evaluation, reserving, and resolution in accordance with state regulations and internal guidelines.

• Establish, monitor, and adjust claim reserves within assigned authority while maintaining thorough file documentation.

• Review and authorize medical, indemnity, and legal payments in alignment with jurisdictional requirements.

• Negotiate settlements consistent with California guidelines and industry best practices.

• Communicate effectively with clients, injured employees, attorneys, medical providers, and internal stakeholders; participate in claim reviews and audits as required.

• Minimum Qualifications

• 10+ years of end-to-end workers’ compensation claims adjusting experience.

• Direct hands-on experience managing California jurisdiction claims.

• Strong written and verbal communication skills with the ability to manage deadlines and competing priorities.

• Core Tools & Systems

• Microsoft Office Suite (Word, Excel, Outlook)

• Claims management systems (claim administration platforms)

• Electronic document management systems (EDMS)

• Email and calendar platforms

• Virtual meeting platforms (video conferencing tools)

Preferred Skills

• California Self-Insurance Plan (SIP) certification.

• Experience presenting during claim reviews.

• AIC, ARM, or CPCU designation.

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