Senior Workers’ Compensation Claims Specialist

Senior Workers’ Compensation Claims Specialist

Requirements

• 10+ years of experience handling California workers’ compensation claims, including litigated cases.
• Deep knowledge of California jurisdiction regulations and procedures.
• Strong organizational, documentation, and follow-up skills to manage a complex caseload.
• Proficiency in Microsoft Office (Word, Excel, Outlook).
• Excellent verbal and written communication skills.
• Commitment to exceptional customer service and a client-focused approach.

Responsibilities

• Investigate, evaluate, and manage California workers’ compensation claims from inception to resolution.
• Handle primarily litigated claims, collaborating closely with defense attorneys and external vendors.
• Maintain an organized diary system to track deadlines, follow-ups, and claim developments.
• Establish and adjust reserves in accordance with client and regulatory guidelines.
• Process claim payments, negotiate settlements, and ensure legal compliance.
• Communicate effectively with injured workers, attorneys, medical providers, and clients to facilitate timely claims resolution.
• Prepare detailed reports on claim status, financials, and litigation progress.
• Represent CCMSI at hearings, mediations, and legal proceedings as needed.

Preferred Qualifications

• Self-Insurance Administrator (SIP) certification (Highly Preferred).
• Associate in Claims (AIC) certification.