CA Senior Claims Specialist

Jobgether SRL; United States; Remote; USD 84,100,000 - 135,476,000; Full time

Benefits offered by this job

Medical coverage (HDHP options)

Dental and vision insurance

Life and long-term disability

401(k) and Roth 401(k)

Paid time off

Job summary

Jobgether SRL is partner-led and seeks a CA Senior Claims Specialist to manage complex Workers’ Compensation claims in California. This fully remote, full-time role focuses on investigation, reserving, and favorable outcomes while coordinating with case managers, attorneys, and customers.

You will ensure compliance with state rules, support team knowledge, and drive cost-containment through strategic action plans and effective communication with stakeholders.

Qualifications

• Bachelor’s degree or an equivalent combination of education and relevant professional experience.
• Minimum of 3 years of industry experience and Workers’ Compensation claim-handling experience.
• Current state certification or license as an experienced claims adjuster.
• Current Workers’ Compensation license or certification that can be maintained throughout employment.

Responsibilities

• Receive and manage Workers’ Compensation claims while confirming policy coverage.
• Investigate claims to determine validity and compensability, gathering information and state documentation.
• Establish claim reserves and authorize payments within limits.
• Develop action plans with case managers to reduce claim costs.
• Coordinate early return-to-work initiatives with stakeholders.
• Manage subrogation, litigation, and potential recoveries through the claim lifecycle.
• Communicate claim status and updates to customers and claimants.
• Ensure compliance with state Workers’ Compensation rules and guidelines.

Skills

Claims administration

Analytical skills

Communication

Microsoft Office (Excel)

Education

Bachelor’s degree or equivalent

Tools

Excel

Job description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a CA Senior Claims Specialist based in the United States. As a CA Senior Claims Specialist, you will manage complex and high-profile Workers’ Compensation claims from initial investigation through resolution. You will evaluate claim validity and compensability, establish appropriate reserves, authorize payments, and develop strategies that support favorable outcomes. The role involves close collaboration with case managers, attorneys, customers, claimants, and other stakeholders throughout the claims lifecycle. You will also oversee subrogation, litigation, recovery opportunities, return-to-work initiatives, and excess carrier reporting when applicable. Strong judgment, organization, and communication skills are essential to balancing cost management, regulatory requirements, and customer service expectations. The position offers an opportunity to apply advanced claims expertise while supporting team development and contributing to broader claims administration and cost-containment objectives. This is a full-time, fully remote position serving Workers’ Compensation claims in California.

Accountabilities

• Receive and manage Workers’ Compensation claims while confirming policy coverage and acknowledging claims appropriately.
• Investigate claims thoroughly to determine validity and compensability, gathering relevant information and completing required state documentation.
• Establish claim reserves and authorize payments within designated reserving authority limits.
• Develop, document, and manage action plans in collaboration with case managers and outcomes managers to reduce overall claim costs.
• Coordinate early return-to-work initiatives with appropriate stakeholders.
• Manage subrogation, litigation, and potential claim recoveries throughout the claim lifecycle.
• Report claims to excess carriers when applicable and maintain appropriate documentation.
• Communicate claim status, decisions, and relevant updates clearly with customers and claimants.
• Follow applicable client and carrier guidelines and participate in claims reviews as required.
• Build and maintain professional relationships with customers and internal stakeholders.
• Ensure compliance with applicable state Workers’ Compensation rules, regulations, and requirements.
• Support team members in developing their knowledge and understanding of claims practices.
• Follow workplace safety requirements and applicable injury and illness prevention procedures.
• Perform additional duties and responsibilities as assigned.

Requirements

• Bachelor’s degree or an equivalent combination of education and relevant professional experience.
• Minimum of 3 years of industry experience and Workers’ Compensation claim-handling experience.
• Current state certification or license as an experienced claims adjuster.
• Current Workers’ Compensation license or certification that can be maintained throughout employment.
• Self-Insured Certificate is preferred.
• Strong knowledge of Workers’ Compensation claims administration, case management, and cost-containment practices.
• Excellent written and verbal communication skills.
• Strong analytical, problem-solving, and decision-making abilities.
• Proficiency with Microsoft Office, including Excel and spreadsheet-based work.
• Strong interpersonal, organizational, and time-management skills.
• Ability to work independently while collaborating effectively within a team environment.
• Ability to manage complex claims with sound judgment, attention to detail, and a customer-focused approach.
• Ability to support and coach colleagues by sharing claims knowledge and best practices.

Benefits

• Hourly pay range of approximately $29.35–$47.28, depending on location, experience, qualifications, and other relevant factors.
• Full-time, fully remote work arrangement.
• Medical coverage, including HDHP options with pharmacy benefits.
• Dental and vision insurance.
• Long-term disability and life insurance.
• Health Savings Account and Flexible Spending Account options.
• Accident and critical illness insurance.
• Pre-paid legal insurance.
• Parking and transit FSA accounts.
• 401(k) and Roth 401(k) retirement plans.
• Paid time off.
• Opportunity to work on complex Workers’ Compensation claims and develop advanced claims expertise.
• Collaborative environment with opportunities to support team development and professional growth.

How Jobgether Works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.