CA Senior Claims Specialist

United StatesRemoteFull-timesenior

Legal & ComplianceClaims Specialist

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Quick Summary

Key Responsibilities

Bachelor’s degree or an equivalent combination of education and relevant professional experience. Minimum of 3 years of industry experience and Workers’ Compensation claim-handling experience.

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Legal & ComplianceClaims Specialist

As a CA Senior Claims Specialist, you will manage complex and high-profile Workers’ Compensation claims from initial investigation through resolution.
You will evaluate claim validity and compensability, establish appropriate reserves, authorize payments, and develop strategies that support favorable outcomes.
The role involves close collaboration with case managers, attorneys, customers, claimants, and other stakeholders throughout the claims lifecycle.
You will also oversee subrogation, litigation, recovery opportunities, return-to-work initiatives, and excess carrier reporting when applicable.
Strong judgment, organization, and communication skills are essential to balancing cost management, regulatory requirements, and customer service expectations.
The position offers an opportunity to apply advanced claims expertise while supporting team development and contributing to broader claims administration and cost-containment objectives.
This is a full-time, fully remote position serving Workers’ Compensation claims in California.

Receive and manage Workers’ Compensation claims while confirming policy coverage and acknowledging claims appropriately.
Investigate claims thoroughly to determine validity and compensability, gathering relevant information and completing required state documentation.
Establish claim reserves and authorize payments within designated reserving authority limits.
Develop, document, and manage action plans in collaboration with case managers and outcomes managers to reduce overall claim costs.
Coordinate early return-to-work initiatives with appropriate stakeholders.
Manage subrogation, litigation, and potential claim recoveries throughout the claim lifecycle.
Report claims to excess carriers when applicable and maintain appropriate documentation.
Communicate claim status, decisions, and relevant updates clearly with customers and claimants.
Follow applicable client and carrier guidelines and participate in claims reviews as required.
Build and maintain professional relationships with customers and internal stakeholders.
Ensure compliance with applicable state Workers’ Compensation rules, regulations, and requirements.
Support team members in developing their knowledge and understanding of claims practices.
Follow workplace safety requirements and applicable injury and illness prevention procedures.
Perform additional duties and responsibilities as assigned.

Requirements

~1 min read

Bachelor’s degree or an equivalent combination of education and relevant professional experience.
Minimum of 3 years of industry experience and Workers’ Compensation claim-handling experience.
Current state certification or license as an experienced claims adjuster.
Current Workers’ Compensation license or certification that can be maintained throughout employment.
Self-Insured Certificate is preferred.
Strong knowledge of Workers’ Compensation claims administration, case management, and cost-containment practices.
Excellent written and verbal communication skills.
Strong analytical, problem-solving, and decision-making abilities.
Proficiency with Microsoft Office, including Excel and spreadsheet-based work.
Strong interpersonal, organizational, and time-management skills.
Ability to work independently while collaborating effectively within a team environment.
Ability to manage complex claims with sound judgment, attention to detail, and a customer-focused approach.
Ability to support and coach colleagues by sharing claims knowledge and best practices.