Senior Workers' Comp Claims Adjuster — Complex Claims

Old Republic Commercial Risk; Roseville (CA); On-site; USD 80,000 - 105,000; Full time

Job summary

Old Republic Commercial Risk in Roseville, CA is seeking a seasoned Workers' Compensation claims professional to independently investigate, evaluate, and resolve highly complex claims. You will determine coverage, reserves, and settlements, collaborate with PMA nurses to implement return-to-work plans, and manage vendor relationships to optimize outcomes.

The role requires 3–5 years of WC claims experience, CA jurisdiction familiarity, and an active license or ability to obtain within 90 days.

Qualifications

• Bachelor's degree or 4+ years of equivalent experience in an insurance-related industry.
• 3–5 years' experience handling lost-time workers' compensation claims; California jurisdiction experience required.
• Active license required or ability to obtain within 90 days in mandated states.

Responsibilities

• Promptly investigate all assigned claims with minimal supervision, including complex cases.
• Determine coverage, compensability, potential for subrogation, and second injury fund when applicable.
• Alert Supervisor and SIU to potentially suspect claims.
• Ensure timely denial or payment of benefits per jurisdictional requirements.
• Establish and adjust reserves with documented rationale.
• Negotiate settlements with client approval.
• Collaborate with PMA nurses to develop return-to-work strategies.
• Select and manage service vendors to balance expense and loss outcome.
• Maintain knowledge of jurisdictional requirements and case law for states served.
• Communicate with internal and external parties on claims and account issues.
• Provide high degree of customer service during reviews and sessions.
• Authorize treatment per PMA protocols.
• Assist PMA clients with panel provider information as per state statutes.

Skills

Organizational skills

Critical thinking

Verbal and written communication

MS Office

Time management

Travel availability

Education

Bachelor's degree or equivalent experience

AIC designation or similar

Tools

MS Office

Job description

Old Republic Commercial Risk in Roseville, CA is seeking a seasoned Workers' Compensation claims professional to independently investigate, evaluate, and resolve highly complex claims. You will determine coverage, reserves, and settlements, collaborate with PMA nurses to implement return-to-work plans, and manage vendor relationships to optimize outcomes.

The role requires 3–5 years of WC claims experience, CA jurisdiction familiarity, and an active license or ability to obtain within 90 days.