Key Responsibilities

Claims Management

• Analyze, investigate, and manage complex CA workers’ compensation claims to assess exposure and ensure proper adjudication.
• Develop proactive action plans to drive timely and appropriate claim resolutions.
• Calculate, assign, and continually evaluate reserve adequacy.
• Determine and issue benefits accurately and on schedule.
• Prepare and submit required state filings within statutory timelines.
• Maintain well-documented claim files with accurate claim coding.

Litigation & Negotiation

• Lead and manage the litigation process, ensuring cost‑effective and timely resolution.
• Negotiate settlements within assigned authority levels.
• Coordinate and oversee vendor services (e.g., investigators, attorneys).

Cost Containment & Recovery

• Apply strategic cost‑management techniques through vendor partnerships.
• Pursue and manage all applicable recoveries, including
• Subrogation
• Second Injury Fund recovery
• Social Security and Medicare offsets
• Report qualifying claims to excess carriers and respond promptly to their directives.

Client & Stakeholder Communication

• Maintain professional communication with claimants, clients, and internal partners.
• Provide clear updates on claim status, activity, and resolution strategies.
• Escalate cases to supervisors or management as appropriate.

Additional Responsibilities

• Support organizational quality and compliance programs.
• Perform other duties as assigned.
• Travel occasionally, as required.

Qualifications

Education & Licensing

• Bachelor’s degree preferred.
• SIP Certification required.
• Additional industry certifications (e.g., WCCA/WCCP) a plus.

Experience

• Minimum 5 years of workers’ compensation claims management experience, or an equivalent combination of education and experience.
• Strong knowledge of California workers’ compensation laws, regulations, and best practices.

Apply now