Senior California Workers’ Compensation – Complex Indemnity

About the role

We are seeking an experienced and highly skilled Senior Workers’ Compensation Claim Consultant to manage a complex California claims portfolio, including claims involving traveling and multi-location employees with stipend and per diem wage structures. This role requires advanced professional judgment, strong regulatory knowledge, and the ability to independently manage wage calculations, claim strategy, and dispute resolution.

Responsibilities

• Investigate, evaluate, and adjust Workers’ Compensation claims in accordance with established claim handling standards and California law.
• Independently manage complex indemnity claims, including those involving traveling employees and variable wage structures.
• Calculate and document Average Weekly Wage (AWW) in accordance with California Labor Code, including analysis of stipends, per diem, and living allowances.
• Establish reserves and/or provide reserve recommendations within established authority levels.
• Review, approve, or provide oversight of medical, legal, damage estimates, and miscellaneous invoices to determine if reasonable and related to designated claims; negotiate disputed bills as needed.
• Authorize and issue claim payments in accordance with claim procedures, industry standards, and established payment authority.
• Negotiate settlements within Corporate Claim Standards, client-specific handling instructions, and applicable state laws.
• Assist in the selection, referral, and supervision of outside vendors (e.g., legal counsel, surveillance, case management).
• Assess and monitor subrogation claims for resolution.
• Review and maintain an accurate personal diary in the claim system.
• Prepare claim status reports, payment summaries, and reserve reports as requested.
• Compute and adjust disability rates in compliance with California regulations.
• Maintain effective, timely communication with clients, claimants, employers, attorneys, and vendors throughout the claim lifecycle.
• Attend and participate in hearings, mediations, WCAB proceedings, and informal legal conferences, as appropriate.
• Conduct claim reviews and/or training sessions for designated clients, as requested.
• Provide notices of qualifying claims to excess and reinsurance carriers.
• Handle more complex and involved claims than lower-level claim positions with minimal supervision.
• Ensure compliance with Corporate Claim Handling Standards and special client handling instructions.

Qualifications

• Five (5) or more years of California Workers’ Compensation claims experience, managing full life-cycle claims.
• Demonstrated experience handling complex indemnity claims with minimal supervision.
• Hands-on experience calculating California AWW, including claims involving stipends, per diem, or other non-traditional wage components.
• Strong understanding of California Labor Code and WC regulations related to wage determination and benefit calculations.
• Ability to independently evaluate and defend wage determinations when disputed.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.
• Adjuster license as required by jurisdiction; California SIP preferred or ability to obtain within the first year of employment.

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy)
• + 10 paid holidays in your first year
• Comprehensive benefits : Medical, Dental, Vision, Life, and Disability Insurance
• Retirement plans : 401(k) and Employee Stock Ownership Plan (ESOP)
• Career growth : Internal training and advancement opportunities
• Culture : A supportive, team-based work environment