Workers Compensation Senior Claim Representative

Workers Compensation Lost Time Senior Claim Examiner 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. 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).

Created: 2026-03-04