Claims Specialist, Workers Compensation

Trucordia

Workers Compensation Claims Advocate serving as strategic advisor between clients and insurance carriers. Managing claims processes, promoting best practices, and supporting clients at Trucordia.

Posted 7/30/2026full-timeRemote • California • 🇺🇸 United StatesSeniorLead💰 $85,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing workers' compensation claims, including advocacy for investigations, cost containment, and compliance with CA WCAB processes. Proficient in analyzing claims data and providing strategic guidance to clients while ensuring effective communication and collaboration.

Highest-signal resume keywords

7-10+ Years CA Workers’ Compensation Claims HandlingSIP CertificateStrong Understanding of CA WCAB ProcessesProficiency with Excel and RMIS PlatformsAbility to Interpret Loss Runs and Actuarial Data

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Workers’ Compensation Claims HandlingClaims Strategy DevelopmentCost ContainmentFraud PreventionLoss Run AnalysisReserve Accuracy EvaluationMedical Treatment Plan GuidanceClaims Handling ProtocolsBill Review EvaluationUtilization Review Programs

Soft Skills

Excellent Communication SkillsTeam PlayerProactive Support

Tools & Technologies

ExcelWordRMIS Platforms

Certifications & Qualifications

SIP Certificate

Industry Keywords

CA WCAB ProcessesClaims HandlingSub-Rosa SurveillanceMedical Provider NetworksLegislative ChangesClaim TrendsReturn-to-Work Strategies

About the role

Key responsibilities & impact

Act as the primary point of contact for clients regarding workers’ compensation claims.
Advocate for aggressive investigation of questionable claims and use of sub-rosa surveillance when appropriate.
Monitor open claims to ensure timely and appropriate handling by Carriers/TPAs.
Provide guidance on claim strategy and resolution options.
Identify opportunities for claim closure, cost containment, and fraud prevention.
Assist clients in understanding claim status, medical treatment plans, and return-to-work strategies.
Educate clients on the use of Medical Provider Networks (MPNs) and help identify quality care providers.
Work with clients and Carriers/TPAs to establish and enforce claims handling protocols.
Evaluate Carriers/TPA’s bill review and utilization review programs.
Ensure quarterly claim reviews are conducted and assist in preparing claim summaries and presentations for client meetings.
Review and analyze loss runs, claim trends, and reserve accuracy.
Prepare projected experience mods ratings and explain increases or decreases.
Stay current on legislative changes and industry trends affecting workers’ compensation.

Requirements

What you’ll need

Bachelor's Degree or higher is desired but not required if appropriate work experience is present
7-10+ years CA workers’ compensation claims handling or consulting - required
SIP certificate required
Strong understanding of CA WCAB processes, reserves, litigation strategy - required
Ability to interpret loss runs, mod worksheets, and actuarial data
Excellent communication skills - both written and oral
Proficiency with Excel, Word, and RMIS platforms
The ability to be a team player and proactively support others

Benefits

Comp & perks

Medical, Dental, Vision
Life Insurance and AD&D
FSA / HSA
Accident Insurance
Critical Illness Insurance
Hospital Indemnity Insurance
Supplemental Health Insurance
EAP
Pet Insurance
11 Paid Holidays
Flexible PTO
401K