California Workers' Compensation Claims Representative | Remote

Our client is looking for an experienced Senior Workers’ Compensation Claims Examiner to manage a portfolio of complex California workers’ compensation claims from inception through final resolution. This role requires deep technical expertise, sound judgment, and the ability to independently handle high-exposure and litigated matters while delivering strong claim outcomes and exceptional service.

The ideal candidate is confident navigating California-specific regulations, skilled in negotiation strategy, and comfortable collaborating with legal counsel and medical professionals to drive efficient and compliant claim resolution.

Responsibilities
• Independently manage a caseload of complex indemnity and litigated California Workers’ Compensation claims.
• Conduct detailed investigations to determine compensability, exposure, and appropriate claim strategy.
• Establish and maintain accurate financial reserves based on claim developments, medical exposure, and legal considerations.
• Direct litigation strategy in partnership with defense counsel, including evaluation of AME/QME reports and deposition testimony.
• Evaluate permanent disability exposure and calculate benefits in accordance with California rating guidelines.
• Negotiate settlements, including Compromise & Release and Stipulated Award agreements, within granted authority levels.
• Ensure timely administration of indemnity benefits and medical payments in compliance with statutory requirements.
• Maintain proactive diary management and move files efficiently toward resolution.
• Identify subrogation opportunities and coordinate recovery efforts when applicable.
• Provide clear and timely communication to injured workers, employers, brokers, and internal stakeholders. Analyze claim trends, identify risk drivers, and recommend strategies to mitigate overall loss exposure.
• Participate in roundtables and peer file reviews to ensure technical accuracy and best practices.

Requirements
• Minimum 5+ years handling California Workers’ Compensation claims, including complex indemnity and litigated files.
• Strong background managing high-severity and high-exposure claims.
• Experience working for an insurance carrier or third-party administrator (TPA).
• Active California Workers’ Compensation Adjuster License preferred.
• Proven ability to set and manage reserves effectively.
• Demonstrated expertise in California Labor Code, DWC procedures, disability rating, and settlement practices.
• Skilled negotiator with strong litigation management capabilities.
• Proficient in claims management software and documentation systems.
• Strong analytical thinking and sound decision-making skills.

Salary & Benefits
• $42.00 – $55.00 per hour (depending on experience)
• Remote work flexibility within California
• Comprehensive health benefits package (Medical, Dental, Vision, Life) while on assignment
• Temporary-to-Hire opportunity within 1-3 months

Apply Now

Apply Now