Senior Workers Compensation Claims Examiner

🕒 5 days ago

🏄 California – Remote

🏄 California – Remote

💵 $95k - $110k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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Acrisure

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2013

💼 Consulting

🏥 Healthcare

📣 Marketing

Consulting • Healthcare • Marketing

Acrisure is a company that provides a wide range of insurance, risk management, and financial services solutions. They offer personal insurance, mortgages, business insurance, and employee benefit services, as well as cybersecurity and managed IT resources. Acrisure is known for expanding their reinsurance capabilities internationally and has garnered recognition such as the 'Broker of the Year' award. The company is also involved in community outreach and partnerships, such as with the Pittsburgh Steelers. Acrisure is committed to delivering innovative solutions and maintaining strong industry leadership.

📋 Description

• Independently manage a caseload of California workers' compensation claims from assignment through resolution • Investigate claims, evaluate compensability, and determine appropriate claim handling strategies • Review coverage, liability, medical documentation, and claim exposure in accordance with California regulations • Establish and manage reserves based on claim exposure and ongoing developments • Manage complex indemnity claims, including litigated files and settlement negotiations • Coordinate with defense counsel, medical providers, employers, and other stakeholders throughout the claims process • Monitor claim progress, maintain accurate diaries, and ensure timely follow-up on all assigned files • Coordinate return-to-work efforts and support positive claim outcomes • Identify fraud, subrogation, and cost containment opportunities when appropriate • Maintain complete, accurate, and timely documentation within the claims management system • Provide guidance and claim recommendations on complex files as needed • Perform additional duties and projects as assigned

🎯 Requirements

• 5+ years of experience handling California workers' compensation claims required • Experience managing indemnity claims required • Experience handling litigated workers' compensation claims required • Current California Adjuster Certification, OSIP/SIP self-insured qualification, or Certified Workers' Compensation Professional (CWCP) designation required • Strong knowledge of California workers' compensation laws, regulations, and claims handling practices • Experience developing claim resolution strategies and negotiating settlements • Ability to independently manage complex claims with minimal supervision • Strong analytical, decision-making, and problem-solving skills • Excellent verbal and written communication skills • Strong organizational skills with the ability to manage multiple priorities 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 • 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 • Paid paternity leave (including for adoptive parents) • Legal plan options • Pet insurance coverage