Title: Workers Compensation Claims Specialist Location: San Francisco United States $ 79999 - $ 99999 / Year Human Resources Permanent Job Description: LHH is working with a leading organization is seeking a Senior-level Workers' Compensation Claims Specialist to manage a high-volume California desk with a strong focus on litigated claims. This is a fully remote, direct hire opportunity for an experienced adjuster who thrives in a fast-paced environment and can independently drive claims to resolution. This is not a training role-success requires strong technical expertise, accountability, and consistent execution. Key Responsibilities - Manage end-to-end California workers' compensation claims, including litigated files - Develop and execute Plans of Action (POAs) to proactively move claims forward - Handle a high-volume caseload, completing 5-8 POAs daily - Evaluate exposure and set/adjust reserves based on claim developments - Partner with and direct defense counsel on litigation strategy - Drive case progression through hearings, conferences, and escalations - Maintain accurate, timely, and compliant documentation - Effectively prioritize across medical, legal, and administrative workflows Required Qualifications - 5+ years of California workers' compensation claims experience - Strong litigation handling experience (beyond basic exposure) - Proven ability to manage a full desk independently - Demonstrated success working remotely with minimal supervision - Strong understanding of: - Claims lifecycle management - Reserve setting and exposure analysis - Litigation strategy and discovery What We're Looking For - Execution-driven adjusters who follow through-not just document - Proactive, diary-driven approach to claims management - Strong ownership mentality and accountability - Excellent time management and prioritization skills - Ability to communicate effectively in a remote environment - Comfortable escalating issues early and managing competing priorities Preferred Background - Experience in high-volume or large TPA environments - Track record of stable tenure and consistent performance - Experience managing complex, litigated claims independently Compensation & Benefits - Base Salary: $80,000 - $100,000 - Bonus: Performance-based (~4%) - Work Arrangement: Fully Remote - Employment Type: Direct Hire Apply Today If you're a senior-level CA claims adjuster who brings both technical depth and strong execution, we'd love to connect. Posting Managed by Nadina Jackson "Equal Opportunity Employer/Veterans/Disabled The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable: - The California Fair Chance Act - Los Angeles City Fair Chance Ordinance - Los Angeles County Fair Chance Ordinance for Employers - San Francisco Fair Chance Ordinance" Pay Details: $79,999.00 to $99,999.00 per year Search managed by: Nadina Jackson Equal Opportunity Employer/Veterans/Disabled The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable: - The California Fair Chance Act - Los Angeles City Fair Chance Ordinance - Los Angeles County Fair Chance Ordinance for Employers - San Francisco Fair Chance Ordinance Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

• Support daily claims activities of the Safety team by managing assigned claims • Coordinate and oversee auto, general liability, property damage, and workers’ compensation claims administered by third-party administrators (TPAs) • Support state and self-funded workers’ compensation programs through claim oversight, documentation review, and ongoing coordination with TPAs and vendors • Review claim activity, summaries, reserves, and recommendations provided by TPAs and escalate issues, trends, or concerns as appropriate • Maintain strong working relationships with insurance carriers, TPAs, brokers, and vendors • Coordinate and participate in quarterly meetings with insurance brokers and insurance carriers • Collaborate with Legal on litigation matters • Review and evaluate legal invoices and related expenses for accuracy • Maintain working knowledge of OSHA rules and regulations • Independently address routine claim coordination matters and escalate complex issues as needed • Perform advanced and often confidential administrative duties related to claims • Produce high-quality reports, presentations, and spreadsheets related to claims activity

Role Description This position is responsible for the review of policy benefit eligibility in accordance with policy, company, state, and federal guidelines. This position is for Long Term Care Insurance Plans administered by Prudential. Supervisory Responsibilities - None Duties/Responsibilities - Responsible for accurate/timely daily review of Long-Term Care benefit eligibility in accordance with policy provisions to determine appropriate eligibility approval or denial. - Responsible for accurate/timely determination of benefits and additional benefits applicable under policy provisions such as Wavier of Premium, Inflation Protection Options, Guaranteed Purchase Options, and other applicable rider/policy benefits. - Responsible for interpreting policy provisions to accurately determine claim benefits in accordance with policy benefits. - Responsible for timely request of claimant’s assessment and follow-up request of any/all required additional information, i.e., medical records, appropriate forms, statements, and certificates needed for proper eligibility determination. - Ensure systems and documents are updated on all follow-ups and status throughout the eligibility process. - Review and work other applicable reports and documents pertaining to eligibility determination. - Responsible for sending correspondence timely to claimant about benefit eligibility determination. - Respond appropriately and professionally to all oral and written external and/or internal correspondences received from stakeholders regarding benefits, eligibility, claim payments, denials and/or explanation of benefits. - Ensure appropriate systems are updated timely and clearly regarding eligibility rationale on how determinations were made in accordance with policy provisions and documents received. - Work with management, medical director, and client on review of complex eligibility cases. - Maintain current knowledge of federal, state, and insurance regulations and requirements. - Maintain working knowledge of all company and services pertaining to business segment. - Maintain working knowledge and proficiency in company claims and administrative software systems as well as Microsoft applications. - Maintain client and company quality and production standards. - Maintain knowledge of applicable company policies and procedures. - Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information. - Interact professionally with other business units to gather and analyze data needed to properly adjudicate claims and documentation of claims files. Qualifications - Excellent oral, written and interpersonal communication skills. - Knowledge of Microsoft Office applications and telephone protocol. - Exceptional listening and analytical skills. - Strong knowledge of customer care processes and techniques. - Demonstrated ability to work well in a team environment. - Dedication to providing exceptional customer service. - Proven leadership experience. - Ability to provide and support company goals. Education and Experience - Two years certificate/degree from college or technical school; or 4-7 years related experience and/or training; or equivalent combination of education and experience. Physical Requirements - N/A Company Description At Wellcove, we strive to create an inclusive culture for all. We understand the importance of listening and incorporating various perspectives at every level of service. Our company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability.

Role Description To assure the consistent application of company procedures and practices in commercial, residential, farm property and property damage liability claim handling, so as to have a significant and positive overall effect on the company. To provide quality service to insureds and aid in the retention of business. To make certain that claims are properly investigated, evaluated and resolved within the company's contractual and legal obligations. To ensure timely service, while providing appropriate and equitable resolution to insureds, claimants and the company. Responsibilities - Investigate, evaluate and control property and casualty claims under minimal supervision. - Maintain advanced knowledge of various types of buildings, construction, repair cost and methods, repair-estimating system and scoping damages. - Assist in training others on repair estimating system and scoping of damage. - Maintain advanced knowledge of farm machinery, livestock and home furnishings. Qualifications - Bachelor’s degree required with focus on construction trades, agriculture-related studies, business administration or insurance related field preferred, or equivalent experience may be considered. - Minimum five to seven years multi-line or property claims experience required. - Advanced knowledge of insurance contracts written by the companies required. - Advanced knowledge of company and divisional policies and procedures required. - Must possess outstanding listening and superior customer service skills. - Advanced knowledge of estimating systems and construction requirements and methods required. - Must have access to high speed Internet at home if position is field-based. - Must possess a valid driver license with an acceptable driving record. - Designations in INS, AIC and/or similar professional insurance designation required. Requirements - Designation in CPCU preferred. - This is a work from home position primarily covering these Michigan counties: Arenac, Bay, Clinton, Genesee, Gratiot, Huron, Ingham, Ionia, Lapeer, Mecosta, Saginaw, Sanilac, Shiawassee, Tuscola. - This is a field position and candidate must reside in the state of Michigan. - If a candidate is not identified, a Property Claims Representative may be considered based on level of experience. Benefits - Farm Bureau offers a full benefit package including medical, dental, vision, and 401K.