Workers' Compensation Claims Manager - AC

Position:Workers' Compensation Claims Manager
Location: Pasadena, CA
Type: Full-time, Direct Hire
Salary Range: $70,000 - $103,000 per year

We are currently seeking a dedicated and experienced Workers' Compensation Claims Manager to join our client's team in Pasadena, CA.

Job Duties:

• Conduct thorough investigations into Workers' Compensation Claims by collating information from various sources such as claimants, witnesses, medical records, and incident reports.
• Evaluate policy coverage to ensure alignment between reported injuries/illnesses and the Workers' Compensation policy.
• Maintain consistent and clear communication channels with injured employees, employers, healthcare providers, and legal representatives throughout the claims process.
• Meticulously document all interactions, actions taken, and decisions made during the claims progression.
• Analyze medical records to assess injury severity and determine appropriate compensation.
• Collaborate closely with healthcare professionals to understand treatment plans, prognoses, and potential return-to-work timelines.
• Calculate and determine fair compensation or benefits, considering injury severity, medical costs, and other pertinent factors.
• Engage in negotiations with claimants, legal representatives, and other involved parties to reach settlements adhering to policy terms and legal requirements.
• Stay updated on relevant Workers' Compensation laws and regulations to ensure full compliance.
• Prepare and manage comprehensive documentation for legal proceedings, including hearings and appeals.
• Analyze claims data to identify patterns, trends, and areas for continual improvement in claims management procedures.
• Generate and present regular reports to management and stakeholders concerning claim status, financial reserves, and essential metrics.
• Deliver exceptional customer service, promptly addressing inquiries and concerns from all involved parties.
• Coordinate effectively with various departments like risk management, legal, and finance for comprehensive claims resolution.
• Identify opportunities for process enhancements and actively contribute to implementing best practices in claims management.

Qualifications:

• Bachelor's degree in insurance, business administration, risk management, or a related field is often preferred.
• Must be bilingual in English and Spanish.
• Possess a valid California Workers' Compensation License.
• 5-7 years of substantial experience in effectively managing Workers' Compensation Claims.
• Demonstrated expertise in Workers' Compensation laws, regulations, and industry practices is crucial. Familiarity with other aspects of insurance and risk management is advantageous.
• Exceptional written and verbal communication skills are essential for effective interaction with claimants, employers, healthcare professionals, and legal representatives.
• Strong negotiation skills are necessary to achieve fair and reasonable settlements with claimants and their legal representatives.
• Proven ability to multitask, manage multiple claims concurrently, prioritize tasks, and meet deadlines effectively.
• Familiarity with claims management software, databases, and other relevant tools is highly beneficial.

Please reach out to Alexis at with any questions.

All qualified applicants will receive consideration for employment without regard torace, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status.We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.