Claims Specialist, Workers Compensation

Trucordia•Fresno, CA

2d•$85,000 - $120,000•Remote

About The Position

As the Workers' Compensation Claims Advocate’s at Trucordia you will serve as a strategic advisor and liaison between clients, insurance carriers, and third-party administrators (TPAs). This role ensures that claims are managed effectively, supports clients in navigating complex claim processes, and promotes best practices in workers’ compensation programs.

Requirements

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

Nice To Haves

Bachelor's Degree or higher is desired but not required if appropriate work experience is present

Responsibilities

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 (In-person or teams meeting as appropriate), assist in preparing claim summaries, and presentations for client meetings. Ensure that a quarterly claim review is conducted close to unit stat filing date.
Complete WC Claim Call Reports that are professional in appearance and consistent in accordance with established standards and provide copies to Producers to support client discussions.
Review and analyze loss runs, claim trends, and reserve accuracy.
Prepare projected experience mods ratings and using the established format to explain increase or decrease.
Stay current on legislative changes and industry trends affecting workers’ compensation. To ensure claims are managed in accordance with state regulations.
Assist Trucordia Account Managers in obtaining experience rating worksheets and responding to WC claim questions.
Provide training and resources to clients on workers’ compensation procedures and process, including the interactive process when returning an employee to work with permanent work restrictions.
Collaborate with Producers and Account Managers to support client retention and new business development.