CA Senior Claims Specialist

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a CA Senior Claims Specialist in United States.

This is a critical role for an experienced claims professional specializing in Workers’ Compensation, focused on managing complex and high-value cases from start to resolution. You will play a key role in ensuring fair, timely, and cost-effective outcomes while maintaining strong relationships with clients, claimants, and legal partners. The position requires a balance of analytical thinking, negotiation expertise, and regulatory knowledge to navigate sensitive and high-impact claims. Working remotely, you’ll collaborate with cross-functional teams to drive effective case strategies and optimize claim performance. This is an opportunity to contribute to a structured yet dynamic environment where precision, accountability, and service excellence are highly valued.

• Manage complex Workers’ Compensation claims from intake through resolution, ensuring compliance with applicable regulations
• Investigate claims thoroughly by gathering documentation, verifying coverage, and determining compensability
• Establish reserves and authorize payments within defined authority levels
• Develop and execute strategic action plans in collaboration with case managers to control claim costs and improve outcomes
• Coordinate return-to-work initiatives with stakeholders to support recovery and reduce claim duration
• Handle subrogation, litigation, and recovery processes, working closely with legal teams as needed
• Communicate claim status and updates clearly with clients, claimants, and other stakeholders
• Maintain accurate documentation and adhere to internal guidelines, client expectations, and regulatory requirements
• Build and sustain strong professional relationships while contributing to team knowledge sharing and best practices

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Requirements:

• Bachelor’s degree or equivalent combination of education and relevant experience
• Minimum of 3 years of experience handling Workers’ Compensation claims, including complex cases
• Valid state certification or license as a claims adjuster, with ongoing compliance requirements
• Strong understanding of claims administration, case management, and cost containment strategies
• Excellent written and verbal communication skills, with the ability to interact effectively with diverse stakeholders
• Proven analytical and problem-solving abilities in high-pressure environments
• Proficiency in Microsoft Office tools, including Excel, and general technical aptitude
• Strong organizational, time management, and multitasking capabilities
• Ability to work independently while collaborating effectively within a team

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Benefits:

• Competitive hourly compensation based on experience, location, and qualifications
• Comprehensive health coverage including medical, dental, and vision plans
• Retirement savings options including 401(k) and Roth 401(k)
• Flexible spending accounts and health savings account options
• Life, disability, accident, and critical illness insurance coverage
• Generous paid time off and leave policies
• Remote work flexibility
• Access to additional benefits such as legal assistance programs and transit-related savings
• Supportive work environment with opportunities for career growth and advancement