Senior Claims Specialist (SIP)

Accountabilities:
The Senior Claims Specialist will oversee complex workers’ compensation claims from initial review through resolution, ensuring compliance, effective cost management, and high-quality service delivery. Review new claims, verify coverage details, and acknowledge claims according to established procedures. Investigate claim validity, determine compensability, collect relevant information, and complete required documentation with applicable agencies. Establish claim reserves and authorize payments within assigned authority limits. Develop and manage detailed action plans with case managers and internal stakeholders to reduce claim costs and improve outcomes. Coordinate return-to-work strategies with appropriate parties to support successful claimant recovery. Manage subrogation activities, litigation processes, and potential recovery opportunities related to claims. Report claims to excess carriers when required and ensure appropriate claim handling procedures are followed. Maintain regular communication with clients, claimants, and stakeholders regarding claim status and resolution progress. Build and maintain professional customer relationships while ensuring client service expectations are met. Remain compliant with applicable state regulations, industry standards, and organizational policies. Support team knowledge sharing and contribute to additional projects as assigned. Requirements: The ideal candidate is an experienced workers’ compensation claims professional with strong analytical abilities, communication skills, and the ability to independently manage complex claim files. They should demonstrate expertise in claims administration, cost containment, and regulatory compliance. 4–5 years of California Workers’ Compensation claims handling experience required. Required California workers’ compensation adjuster license. Experience managing complex and high-value workers’ compensation claims. Experience with SIP claims handling required. Bachelor’s degree or equivalent combination of education and relevant professional experience. Associates in Claims (AIC) or Associates in Risk Management (ARM) designation preferred. Strong understanding of claims administration, case management, and cost containment practices. Excellent written and verbal communication skills. Strong problem-solving abilities with the ability to analyze situations and make sound decisions. Proficiency with Microsoft Office tools, including Excel spreadsheets and related systems. Strong organizational skills, attention to detail, and ability to manage multiple priorities. Ability to work effectively both independently and collaboratively within a team environment. Benefits: Fully remote work opportunity for candidates residing in California. Competitive hourly compensation ranging from $29.35 to $47.28. Comprehensive medical, dental, and vision insurance options. Health Savings Account (HSA) and Flexible Spending Account (FSA) options. Long-term disability and life insurance coverage. Accident and critical illness insurance options. Retirement savings plans, including 401(k) and Roth 401(k) options. Paid time off and employee wellness benefits. Professional development opportunities and career advancement support. Opportunity to work within a stable organization focused on innovation and employee growth.

How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
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