Workers' Compensation Senior Claim Representative

We are currently seeking an experienced Workers Compensation Lost Time Senior Claim Examiner to join our team in the Los Angeles, CA area. As a Workers Compensation Lost Time Senior Claim Examiner, you will handle a caseload of lost time workers compensation claims originating primarily from California. This Workers Compensation Lost Time Senior Claim Examiner role is an on-site position located in Los Angeles and focuses on delivering high-quality claims service in a fast-paced, customer-driven environment.

Responsibilities:

• Manage all aspects of lost time workers compensation claims from initiation through closure.
• Conduct three-part investigations, including statements from insureds, claimants, and medical providers.
• Determine claim compensability based on investigation outcomes.
• Administer statutory medical and indemnity benefits timely and accurately.
• Communicate denials and updates to insureds, claimants, attorneys, and involved parties.
• Set and adjust reserves within authority, escalating when necessary.
• Collaborate with legal counsel on hearings and litigation matters.
• Direct vendors and medical case managers on return-to-work strategies.
• Comply with all state and regulatory reporting requirements.
• Refer appropriate claims for subrogation and maximize recovery efforts.
• Partner with internal teams (nurses, investigators, case managers) for optimal claim outcomes.
• Prepare clear, professional documentation and reports.

Job Requirements:

• Prior experience handling workers compensation lost time claims required.
• Certification to manage California Workers Compensation claims required.
• Experience handling claims in CO, UT, NV, and AZ is a plus.
• Strong communication and analytical skills.
• Proficient in Microsoft Office and electronic claim systems.
• Familiarity with medical terminology and bill processing.
• Proven organizational and time management skills.
• Ability to manage multiple priorities and meet deadlines consistently.
• Commitment to high-quality work and service standards.
• Must obtain or maintain applicable state adjuster licenses as required.

Preferred Qualifications:

• Experience in fast-paced, customer-oriented environments.
• Background in insurance, legal, or corporate business environments.
• AIC, RMA, or CPCU coursework/designations (preferred but not required).