Workers Compensation Claims Representative

Role Description: The Workers Compensation Claims Representative is a full-time, on-site role based in Orange County, CA. This position is responsible for handling and managing workers’ compensation claims from initial notice through resolution, including investigating incidents, gathering documentation, and assessing coverage and liability. The representative will coordinate with policyholders, injured workers, medical providers, and attorneys to ensure timely, fair, and compliant claim outcomes. Daily activities include maintaining accurate claim files, monitoring reserves, preparing reports, and supporting risk management strategies that help clients reduce claim frequency and severity. The role also involves educating clients on workers’ compensation processes and best practices, while providing responsive, professional customer service.

Qualifications: Candidates should possess strong skills in Claims Handling and Claims Management for workers’ compensation cases. Candidates should possess solid knowledge of Insurance principles, particularly commercial and workers’ compensation insurance. Candidates should possess experience related to medical or indemnity evaluation and documentation where applicable to claims. Candidates should possess excellent Customer Service skills, including clear communication and relationship management with clients and claimants. Relevant experience in workers’ compensation claims, risk management, or commercial insurance preferred. Ability to analyze claim information, interpret ex-mods, and make sound, evidence-based decisions. Strong organizational skills, attention to detail, and proficiency with claims management systems and basic office software. High school diploma or equivalent required; additional education or professional insurance designations (e.g., AIC, ARM) are a plus.