Senior WC Claims Investigator (Remote)

Old Republic Commercial Risk; Fresno (CA); On-site; USD 70,000 - 85,000; Full time

Job summary

Old Republic Commercial Risk is seeking a qualified Claims professional in California to independently investigate and resolve complex workers’ compensation claims. You will determine coverage, reserves, and settlements, while coordinating with PMA nurses for return‑to‑work strategies and working with service vendors to balance expenses and outcomes.

The role requires a bachelor's degree or equivalent insurance experience, California jurisdiction knowledge, and the ability to obtain licensure

Qualifications

• Bachelor's degree and/or four or more years of equivalent work experience in insurance required.
• California jurisdiction experience preferred and licensed or able to obtain license within 90 days.
• Familiarity with medical terminology and Workers' Compensation regulations.

Responsibilities

• Investigates assigned claims with minimal supervision, including complex cases.
• Determines coverage, compensability, subrogation potential, and second injury fund applicability.
• Alerts supervisor and SIU to potentially suspect claims.
• Ensures timely denial or payment of benefits per jurisdictional requirements.
• Establishes and adjusts reserves with documented rationale throughout the claim life.
• Negotiates settlements within granted authority and collaborates with vendors and PMA team.

Skills

Communication skills

Customer service

Organizational skills

Analytical thinking

Attention to detail

Education

Bachelor's degree or 4+ years insurance experience

Associate in Claims (AIC) designation

Tools

MS Office (Word, Excel, PowerPoint)

Job description

Old Republic Commercial Risk is seeking a qualified Claims professional in California to independently investigate and resolve complex workers’ compensation claims. You will determine coverage, reserves, and settlements, while coordinating with PMA nurses for return‑to‑work strategies and working with service vendors to balance expenses and outcomes.

The role requires a bachelor's degree or equivalent insurance experience, California jurisdiction knowledge, and the ability to obtain licensure