Senior Workers Compensation Claims Examiner

Next Level Administrators, LLC•*, CA

22d•$90,000 - $100,000•Remote

About The Position

Acrisure is seeking a Senior Workers' Compensation Claims Examiner to independently manage complex California workers' compensation claims from assignment through resolution. The role involves investigating claims, determining compensability, managing litigation, evaluating exposure, and developing resolution strategies while complying with California workers' compensation laws and regulations. Candidates must have direct, hands-on experience handling California workers' compensation claims and one of the specified qualifications: an active California Adjuster Certification, an OSIP/SIP self-insured qualification, or a Certified Workers' Compensation Professional (CWCP) designation. This is described as a fully remote position. Candidates must support California-based claims and work business hours aligned with Mountain or Pacific Time zones. The position requires a high school diploma or equivalent. Additional education is beneficial. The stated base compensation range is $90,000–$100,000, with placement depending on factors including skills, experience, qualifications, location, and internal equity. The posting also says candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.

Requirements

At least 5 years of experience handling California workers' compensation claims.
Experience managing indemnity claims.
Experience handling litigated workers' compensation claims.
Current California Adjuster Certification, OSIP/SIP self-insured qualification, or Certified Workers' Compensation Professional (CWCP) designation.
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 and ability to manage multiple priorities in a remote environment.
Proficiency with Microsoft Office and claims management systems.
High school diploma or equivalent.
Ability to support California-based claims during business hours aligned with Mountain or Pacific Time zones.

Nice To Haves

Additional education.

Responsibilities

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 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.