Workers Compensation Claims Specialist

This is a Contract to Hire hybrid position based in Brea, CA. The position is anticipated to close on Aug 28, 2026.

Responsibilities

• Interprets complex or unusual policy coverages and determines if coverages apply to claims submitted, escalating issues as needed.
• Sets activities, reserves, and authorizes payments within scope of authority.
• Ensures issuance of disbursements while managing loss costs and expenses.
• Coordinates and performs investigations and evaluates claims and suits through contact with insureds, claimants, business partners, witnesses, and experts.
• Seeks early resolution opportunities.
• Identifies files with potential fraud and refers them to the Special Investigations Unit (SIU).
• Utilizes negotiation skills to develop complex settlement packages.
• Identifies claims with third-party recovery potential and coordinates with the subrogation/salvage unit.
• Partners with attorneys, account representatives, agents, underwriters, doctors, nurse case managers, and insureds to develop a focused strategy for timely and cost-effective resolution of more complex claims.
• Analyzes claims activities and prepares and presents reports for management.
• May be responsible for special projects and presentations.
• Ensures accurate input of data reflecting claim circumstances and other important business information.
• May provide guidance and assistance to other claims staff and functional areas.
• Stays current on state/territory regulations, industry activity, and trends.
• Performs additional duties as assigned.

Requirements

• Bachelor’s Degree or equivalent experience.
• Typically a minimum of three to five years of claims experience.
• CA Certification required.
• Professional designations preferred.

Skills

• Solid knowledge of claims and insurance industry theory and practices.
• Demonstrated technical expertise and product-specific knowledge, particularly in workers' compensation claims.
• Strong interpersonal, communication, and negotiation skills.
• Ability to effectively interact with all levels of internal and external business partners.
• Ability to work independently, managing time and resources to accomplish multiple tasks and meet deadlines.
• Strong analytical and problem-solving skills enabling viable alternative solutions.
• Ability to exercise independent judgment and make critical business decisions effectively assessing the merits of claims and evaluating them based on a cost-benefit analysis.
• Solid knowledge of Microsoft Office Suite and other business-related software.
• Ability to adapt to change and value diverse opinions and ideas.
• Ability to fully comprehend claim information and articulate analyses in internal reports.
• Ability to handle claims with a proactive long-term view of business goals and objectives.

Pay

The pay range for this position is $60.00 - $80.00 per hour. Individual compensation offered within this range will depend on qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Benefits

Eligibility requirements apply to some benefits and may depend on job classification and length of employment. Benefits are subject to change and may include specific elections, plan, or program terms. If eligible, benefits for this temporary role may include:

• Medical, dental, and vision insurance.
• Critical Illness, Accident, and Hospital insurance.
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available.
• Life Insurance (Voluntary Life & AD&D for the employee and dependents).
• Short-term and long-term disability.
• Health Spending Account (HSA).
• Transportation benefits.
• Employee Assistance Program.
• Time Off/Leave (PTO, Vacation, or Sick Leave).