Workers Compensation Claims Examiner
Acrisure
full-time
Posted on:
Location Type: Remote
Location: California • United States
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Salary
💰 $80,000 - $95,000 per year
About the role
- Manage a caseload of California workers’ compensation claims from initial assignment through final resolution
- Review and evaluate coverage, liability, and compensability in accordance with California Labor Code and regulatory requirements
- Conduct thorough investigations, including gathering statements, reviewing reports, and analyzing claim documentation
- Set and manage reserves based on exposure and claim developments
- Ensure timely and accurate benefit payments and required communications
- Maintain claim diaries and ensure consistent follow up throughout the life of the claim
- Coordinate return to work efforts and monitor ongoing claim activity
- Oversee litigation, including working with defense counsel and participating in claim strategy discussions
- Negotiate settlements within authority and provide recommendations on cases exceeding authority
- Identify potential fraud, subrogation, and cost containment opportunities
- Maintain accurate and compliant documentation within the claims system
- Communicate effectively with injured workers, employers, medical providers, attorneys, and internal stakeholders
Requirements
- 3+ years of experience handling workers’ compensation claims required
- Current California Adjuster Certification required
- Experience handling California self-insured workers’ compensation claims required, including qualification through the California Office of Self-Insurance Plans (OSIP) or holding a Certified Workers’ Compensation Professional (CWCP) designation required
- Strong knowledge of California workers’ compensation laws and claims handling practices
- Experience managing indemnity claims, litigation, and claim resolution strategies
- Strong analytical, decision making, and problem solving skills
- Excellent verbal and written communication skills
- Strong organizational skills and ability to manage multiple claims
- Ability to work independently in a remote environment
- Proficiency with Microsoft Office and claims management systems
Benefits
- Comprehensive medical insurance
- Dental insurance
- Vision insurance
- Life and disability insurance
- Fertility benefits
- Wellness resources
- Paid sick time
- Generous paid time off and holidays
- Employee Assistance Program (EAP)
- Complimentary Calm app subscription
- Immediate vesting in a 401(k) plan
- Health Savings Account (HSA) and Flexible Spending Account (FSA) options
- Commuter benefits
- Employee discount programs
- Paid maternity leave and paid paternity leave (including for adoptive parents)
- Legal plan options
- Pet insurance coverage
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
workers' compensation claims managementcoverage evaluationliability assessmentcompensability analysisclaims investigationreserve managementsettlement negotiationfraud identificationsubrogationcost containment
Soft Skills
analytical skillsdecision makingproblem solvingverbal communicationwritten communicationorganizational skillsindependent workstakeholder communicationclaim strategy discussionsfollow-up management
Certifications
California Adjuster CertificationCertified Workers’ Compensation Professional (CWCP)