Workers Compensation Claims Examiner

Acrisure•Costa Mesa, CA

4d•Remote

About The Position

Acrisure is seeking a Workers’ Compensation Claims Examiner to manage California-based workers’ compensation claims from assignment through resolution. This role is responsible for investigating claims, determining compensability, managing reserves, and coordinating all aspects of the claims process in compliance with California regulations. Candidates must have direct, hands-on experience managing workers’ compensation claims. They must also have either an active California Adjuster License, experience working with self-insured claims programs (OSIP or SIP), or a Certified Workers’ Compensation Professional (CWCP) designation. This is a fully remote position; however, candidates must be able to support California-based claims and work hours that may be more aligned with Mountain or Pacific Time business operations.

Requirements

3+ years of experience handling workers’ compensation claims required
An active California Adjuster License, experience working with self-insured claims programs (OSIP or SIP), or a Certified Workers’ Compensation Professional (CWCP) designation.
Strong knowledge of California workers’ compensation laws and claims handling practices
Experience managing indemnity claims, litigation, and claim resolution strategies
Strong analytical, decision making, and problem solving skills
Excellent verbal and written communication skills
Strong organizational skills and ability to manage multiple claims
Ability to work independently in a remote environment
Proficiency with Microsoft Office and claims management systems
High school diploma or equivalent required
Current California Adjuster Certification required OR OSIP/SIP Self-Insured qualification OR Certified Workers’ Compensation Professional (CWCP) designation required

Nice To Haves

Additional education beneficial

Responsibilities

Manage a caseload of California workers’ compensation claims from initial assignment through final resolution
Review and evaluate coverage, liability, and compensability in accordance with California Labor Code and regulatory requirements
Conduct thorough investigations, including gathering statements, reviewing reports, and analyzing claim documentation
Set and manage reserves based on exposure and claim developments
Ensure timely and accurate benefit payments and required communications
Maintain claim diaries and ensure consistent follow up throughout the life of the claim
Coordinate return to work efforts and monitor ongoing claim activity
Oversee litigation, including working with defense counsel and participating in claim strategy discussions
Negotiate settlements within authority and provide recommendations on cases exceeding authority
Identify potential fraud, subrogation, and cost containment opportunities
Maintain accurate and compliant documentation within the claims system
Communicate effectively with injured workers, employers, medical providers, attorneys, and internal stakeholders