Senior Workers Compensation Claims Examiner

Acrisure; Red Bluff (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

Acrisure is seeking a Senior Workers' Compensation Claims Examiner to independently manage complex California workers' compensation claims from assignment through resolution. This fully remote role requires active CA Adjuster Certification, SIP/SIP self-insured qualification, or CWCP designation and experience handling self-insured or litigated claims.

Candidates must be proficient in evaluating exposure, negotiating settlements, and coordinating with defense counsel, medical providers, and

Qualifications

• 5+ years of experience handling California workers' compensation claims.
• Experience managing indemnity claims.
• Experience handling litigated workers' compensation claims.
• Current California Adjuster Certification, OSIP/SIP self-insured qualification, or CWCP designation.
• Strong knowledge of California workers' compensation laws, regulations, and claims handling practices.
• Experience developing claim resolution strategies and negotiating settlements.
• Ability to independently manage complex claims with minimal supervision.
• Strong analytical, decision-making, and problem-solving skills.
• Excellent verbal and written communication skills.
• Strong organizational skills with the ability to manage multiple priorities in a remote environment.
• Proficiency with Microsoft Office and claims management systems.

Responsibilities

• Independently manage a caseload of California workers' compensation claims from assignment through resolution
• Investigate claims, evaluate compensability, and determine appropriate claim handling strategies
• Review coverage, liability, medical documentation, and claim exposure in accordance with California regulations
• Establish and manage reserves based on claim exposure and ongoing developments
• Manage complex indemnity claims, including litigated files and settlement negotiations
• Coordinate with defense counsel, medical providers, employers, and other stakeholders throughout the claims process
• Monitor claim progress, maintain accurate diaries, and ensure timely follow-up on all assigned files
• Coordinate return-to-work efforts and support positive claim outcomes
• Identify fraud, subrogation, and cost containment opportunities when appropriate
• Maintain complete, accurate, and timely documentation within the claims management system
• Provide guidance and claim recommendations on complex files as needed
• Perform additional duties and projects as assigned

Skills

CA WC laws

Claims investigation

Litigation handling

Remote work

Communication skills

Education

California Adjuster Certification

CWCP designation

Tools

Microsoft Office

Claims system

Job description

A global fintech leader, Acrisure empowers millions of ambitious businesses and individuals with the right solutions to grow boldly forward. Bringing cutting-edge technology and top-tier human support together, we connect clients with customized solutions across a range of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more.

In the last twelve years, Acrisure has grown in revenue from $38 million to almost $5 billion and employs over 19,000 colleagues in more than 20 countries. Acrisure was built on entrepreneurial spirit. Prioritizing leadership, accountability, and collaboration, we equip our teams to work at the highest levels possible.

Job Summary

Acrisure is seeking a Senior Workers' Compensation Claims Examiner to independently manage complex California workers' compensation claims from assignment through resolution. This role is responsible for investigating claims, determining compensability, managing litigation, evaluating exposure, and developing claim resolution strategies while ensuring compliance with California workers' compensation laws and regulations.

Candidates must have direct, hands-on experience handling California workers' compensation claims. An active California Adjuster Certification, experience handling self-insured claims through the California Office of Self-Insurance Plans (SIP/OSIP), or a Certified Workers' Compensation Professional (CWCP) designation is required.

This is a fully remote position. Candidates must be able to support California-based claims and work business hours aligned with Mountain or Pacific Time zones.

Responsibilities

• Independently manage a caseload of California workers' compensation claims from assignment through resolution
• Investigate claims, evaluate compensability, and determine appropriate claim handling strategies
• Review coverage, liability, medical documentation, and claim exposure in accordance with California regulations
• Establish and manage reserves based on claim exposure and ongoing developments
• Manage complex indemnity claims, including litigated files and settlement negotiations
• Coordinate with defense counsel, medical providers, employers, and other stakeholders throughout the claims process
• Monitor claim progress, maintain accurate diaries, and ensure timely follow-up on all assigned files
• Coordinate return-to-work efforts and support positive claim outcomes
• Identify fraud, subrogation, and cost containment opportunities when appropriate
• Maintain complete, accurate, and timely documentation within the claims management system
• Provide guidance and claim recommendations on complex files as needed
• Perform additional duties and projects as assigned

Requirements

• 5+ years of experience handling California workers' compensation claims required
• Experience managing indemnity claims required
• Experience handling litigated workers' compensation claims requiredCurrent California Adjuster Certification, OSIP/SIP self-insured qualification, or Certified Workers' Compensation Professional (CWCP) designation required
• Strong knowledge of California workers' compensation laws, regulations, and claims handling practices
• Experience developing claim resolution strategies and negotiating settlements
• Ability to independently manage complex claims with minimal supervision
• Strong analytical, decision-making, and problem-solving skills
• Excellent verbal and written communication skills
• Strong organizational skills with the ability to manage multiple priorities in a remote environment
• Proficiency with Microsoft Office and claims management systems

EDUCATION AND LICENSES

• High school diploma or equivalent required
• Additional education beneficial
• Current California Adjuster Certification, OSIP/SIP self-insured qualification, or Certified Workers' Compensation Professional (CWCP) designation required