Senior CA WC Claims Examiner - Remote

Acrisure

Bakersfield (CA)

On-site

USD 110,000 - 140,000

Full time

4 days ago

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Job summary

Acrisure is seeking a Senior Workers' Compensation Claims Examiner to independently manage complex California workers' compensation claims from assignment through resolution. You will investigate claims, determine compensability, manage litigation, evaluate exposure, and develop claim resolution strategies in compliance with California laws.

Candidates must have CA Adjuster Certification, SIP/SIP self-insured qualification, or CWCP designation.

Qualifications

5+ years of experience handling California workers' compensation claims.
Active California Adjuster Certification, OSIP/SIP self-insured qualification, or CWCP designation required.
Ability to work remotely while supporting California-based claims and aligning with MTN/PT hours.

Responsibilities

Independently manage a caseload of CA workers' comp claims from assignment to resolution.
Investigate claims, evaluate compensability, and determine handling strategies.
Review coverage, liability, medical records, and exposure per CA regulations.
Establish and manage reserves based on exposure and developments.
Handle complex indemnity claims, including litigated files and settlements.
Coordinate with defense counsel, medical providers, employers, and stakeholders throughout the process.
Monitor progress, maintain diaries, and ensure timely follow-up on files.
Coordinate return-to-work efforts and support positive outcomes.
Identify fraud, subrogation, and cost containment opportunities when appropriate.
Maintain complete documentation in the claims system.
Provide guidance on complex files as needed.