Workers Compensation Claims Manager

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: San Diego, California, San Diego, CA, Remote

Key Responsibilities

• Supervise, coach, and mentor a team of Workers Compensation Adjusters handling medical-only, indemnity, and litigated claims.
• Conduct regular file reviews, audits, and performance evaluations to ensure compliance with company standards and client requirements.
• Review and approve reserves, settlement recommendations, claim strategies, and authority requests within established guidelines.
• Provide technical guidance on compensability, reserving, litigation management, return-to-work coordination, subrogation, and excess reporting.
• Monitor adjuster productivity, diary management, claim quality, customer service metrics, and file handling practices.
• Support onboarding, training, and professional development of new and existing team members.
• Ensure compliance with state-specific workers compensation laws and client-specific handling instructions.
• Manage escalated and complex claims as needed.
• Collaborate with defense counsel, Nurse Case Managers, medical providers, vocational professionals, and client stakeholders.
• Participate in client meetings, stewardship reviews, and claim strategy discussions.
• Identify trends, process improvement opportunities, and training needs across the team.
• Promote a positive, collaborative, and performance-driven work environment.

Skills, knowledge & expertise

• 5-7 years of Workers Compensation claims handling experience.
• 2-3 years of supervisory, team lead, or claims leadership experience.
• Strong understanding of multi-jurisdictional Workers Compensation statutes and claim handling procedures.
• Experience managing or overseeing medical-only, indemnity, and litigated claims.
• Knowledge of subrogation, excess reporting, reserving practices, and EDI reporting requirements.
• Experience conducting file audits, performance reviews, and coaching adjusters.
• Strong analytical, organizational, and decision-making abilities.
• Excellent written and verbal communication skills.
• Active adjuster license preferred.
• Experience with claims platforms such as Guidewire, RiskMaster, or similar systems preferred.
• Proficiency with Microsoft Office Suite, including Outlook, Excel, and Word.

Equal Employment Opportunity & Legal Notices

• Medical, dental, and vision plans to support your health and that of your family
• A 401(k) plan with employer matching
• Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
• Paid holidays
• Life insurance and short‑term and long‑term disability coverage

• Maintain regular and dependable attendance.
• Be available and able to perform job responsibilities during established work hours.