Sr. Workers Compensation Specialist

Talent Team•Escondido, CA

22h•$104,000 - $130,000

About The Position

The Sr. Workers' Compensation Specialist leads the company’s workers’ compensation, auto liability, and incident claim management process from intake through resolution. This role also oversees general liability, property, and other assigned claims and serves as a subject matter expert and strategic resource to Operations, Safety, Human Resources, Legal, and company leadership on claims, risk exposure, regulatory requirements, return-to-work strategies, and loss prevention. This role partners with operations, safety, human resources, legal counsel, insurance carriers, brokers, third-party administrators, medical providers, and project leadership to ensure timely reporting, effective investigation, regulatory compliance, cost control, and successful return-to-work outcomes. The role also supports broader safety, risk, claims analytics, program management, and continuous improvement initiatives that advance department and company objectives. The Sr. Workers' Compensation Specialist operates with independence and exercises discretion and independent judgment in evaluating complex claims, assessing financial and organizational risk, interpreting regulatory requirements, developing recommendations, and determining appropriate courses of action.

Requirements

3+ years of experience managing workers’ compensation claims, construction claims, casualty claims, safety/risk management, or a closely related function.
Working knowledge of workers’ compensation claim administration, return-to-work practices, OSHA recordkeeping, incident investigation, and risk management principles.
Demonstrated experience independently evaluating claims and risk exposure and developing recommendations for resolution or mitigation.
Experience partnering with insurance carriers, TPAs, brokers, defense counsel, occupational clinics, and operational leaders.
Strong analytical ability with experience reviewing loss runs, reserves, claim trends, and key performance indicators and financial exposure.
Ability to interpret and apply workers’ compensation, OSHA, and related regulatory requirements to business situations.
Excellent written and verbal communication skills with the ability to brief leadership and influence field operations.
Demonstrated ability to exercise discretion and independent judgment when evaluating significant claims, risks, compliance matters, and business considerations.
High discretion and professionalism when handling confidential medical, employment, legal, and claim information.
Proficiency with Microsoft Office, experience with claims, safety, HRIS, RMIS, or EHS management platforms preferred.
Ability to plan and prioritize work to meet claim reporting, regulatory, cost, and operational expectations.
Strong organizational skills and ability to independently plan, prioritize, and manage multiple priorities while meeting claim reporting, regulatory, financial, and operational requirements.
Ability to work effectively with employees and leaders at all levels and influence outcomes through sound analysis, recommendations, and professional judgment.

Nice To Haves

Construction, electrical, specialty contractor, or self-perform field operations experience.
California workers’ compensation and Cal/OSHA experience.
Experience with OCIP/CCIP, subcontractor claims coordination, contractual risk transfer, fleet/auto claims, and general liability claims.
Experience developing executive dashboards, claims analytics, KPI reporting, and trend analysis to support risk management and operational decision-making.
Experience leading or participating in program management and cross-functional process improvement initiatives.
Involvement with program management and cross-functional process improvement initiatives, including working closely with Learning & Development.
Professional credentials such as ARM, AIC, WCCP, or equivalent safety/risk/claims designation.

Responsibilities

Manage workers’ compensation, auto, general liability, property, and other assigned claims from initial notice through closure.
Serve as the primary internal point of contact and subject matter resource for claim intake, documentation, investigation, reserves, litigation strategy, settlement recommendations, and claim closure, exercising independent judgment to evaluate claim circumstances, determine appropriate courses of action, and make recommendations on matters of significance.
Oversee claims are reported timely to the appropriate carrier, broker, TPA, internal stakeholders, and regulatory agencies, as applicable.
Partner with field leadership to obtain complete incident facts, witness statements, photos, root-cause details, corrective actions, and documentation to support accurate claim handling and evaluation of organizational exposure.
Coordinate claim reviews with adjusters, brokers, defense counsel, and company leadership; evaluate claim strategy and challenge reserves and action plans when claim facts, financial exposure, or strategy warrant review.
Evaluate claim status, compensability, medical-only versus indemnity exposure, subrogation opportunities, litigation activity, settlement posture, and closure opportunities; independently assess claim developments and determine when changes in strategy, escalation, or additional resources are warranted.
Maintain clear, accurate, and confidential claim files, communication logs, and supporting records.
Lead Early Return-to-Work (RTW) and modified-duty coordination in partnership with Operations, HR, medical providers, and supervisors.
Obtain and evaluate work status reports, restrictions, job descriptions, and essential-function requirements to support timely and compliant work accommodations decisions.
Monitor lost-time claims, modified duty duration, treatment progression, and barriers to resolution and develop recommendations to improve claim outcomes and reduce unnecessary claim duration and severity.
Exercise independent judgment in evaluating complex return-to-work and accommodation considerations and recommend appropriate courses of action based on applicable requirements and individual circumstances.
Escalate complex cases involving extended disability, litigation risk, employment overlap, accommodation complexity, or potential fraud indicators to the appropriate internal stakeholders with timely communication and appropriate judgment.
Analyze loss runs, claim trends, root causes, severity drivers, open reserves, and total incurred costs to identify risk reduction opportunities and reduce organizational exposure and control costs.
Independently evaluate claims and risk data and develop recommendations for leadership regarding trends, financial exposure, claim strategy, loss prevention, and program performance.
Prepare recurring claims, safety, and risk dashboards for leadership, including lagging indicators, cost trends, claim frequency, severity, open/closed claim status, and return-to-work performance and provide recommendations based on the analysis.
Identify and recommend opportunities to improve claim handling, deductible/SIR management, reserve accuracy, and vendor performance and overall program effectiveness.
Identify emerging trends and risks and recommend proactive strategies to mitigate potential financial, operational, regulatory, and employee impacts.
Oversee OSHA recordkeeping and reporting requirements in coordination with Safety leadership and exercise independent judgment in evaluating recordability and reporting obligations.
Manage OSHA recordability determinations in coordination with Safety leadership and maintain required OSHA Injury and Illness records, including OSHA 300, 300A, and 301 records or equivalent systems.
Evaluate work-related incidents to determine appropriate OSHA recordkeeping and reporting requirements in coordination with Safety leadership.
Ensure timely reporting of work-related fatalities, in-patient hospitalizations, amputations, loss of eye, and other reportable events to Federal OSHA and/or State OSHA programs, as applicable.
Partner with Safety and Operations during OSHA inspections, inquiries, informal conferences, citation response, abatement documentation, and corrective-action tracking, applicable to an incident.
Monitor regulatory changes and evaluate their potential impact on company practices.
Recommend updates to internal recordkeeping, reporting, incident escalation, and compliance procedures based on regulatory changes and organizational needs.