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Examines and adjudicates complex California workers’ compensation claims, including litigated and high-exposure cases. Responsibilities include investigating claims, determining benefits, calculating reserves and payments, negotiating settlements, managing litigation, preparing statutory filings, reporting claims to excess carriers, and identifying subrogation opportunities. The role requires California workers’ compensation expertise, jurisdictional knowledge, strong analytical judgment, and effective claims resolution skills.

Support and maintain claims management systems, manage security access and logins, process claim updates and adjustments, queue claims for Managed Care, run reconciliations, gather audit data, provide telephone support, and collaborate with internal teams to ensure policy compliance.

Leads client service and account management strategies for complex workforce absence programs. Responsibilities include client retention, renewals, contract revisions, stewardship reporting, issue resolution, revenue growth, cross-selling, invoicing coordination, and service-plan negotiation. The role supervises client services personnel, directs cross-functional efforts, ensures quality compliance, and manages major customer service issues for large insurance clients.

Expands company revenue by building and maintaining prospective and existing client relationships in claims and risk management. Identifies sales opportunities, develops service programs, leads RFPs and presentations, coordinates internal resources, supports new-client implementation, and executes annual sales plans. The role is accountable for $2–3 million in sales goals and requires substantial relationship-building experience, negotiation, presentation, and analytical skills.

Processes auto and general liability property damage claims by analyzing coverage, liability, estimates, payments, documentation, subrogation, salvage, and claim resolution. Communicates with insureds, clients, agents, and brokers while meeting regulatory deadlines, maintaining claim files, supporting quality programs, and delivering professional service. State adjusting licenses may be required.

Processes first-party property claims under client-specific coverage guidelines, investigates and evaluates claims, determines benefits, adjudicates settlements or denials, and issues payments or adjustments. Handles high claim volumes, customer calls, and correspondence while maintaining accurate documentation and meeting quality, production, and deadline requirements. Requires professional fluency in Spanish, strong communication and analytical skills, Microsoft Office proficiency, and willingness to obtain required licenses.

Provides executive leadership for enterprise data and generative AI engineering. Owns strategy, governance, architecture, and operations across ETL/ELT platforms, Snowflake, cloud AI ecosystems, feature stores, vectorization, embeddings, and RAG. Leads engineering leaders, establishes financial and operating metrics, ensures regulatory and security alignment, advises executives, and develops organizational talent. The position is remote in the U.S. with travel as required.

Analyzes and adjudicates lower-level workers compensation claims under supervision, determining compensability and benefits due. Processes medical-only and minor lost-time claims, maintains accurate documentation and coding, monitors reserves, files required state documentation, processes routine payments and prescriptions, communicates with claimants, clients, and medical contacts, and supports representatives handling complex claims.

Directs operational and technical functions across assigned offices, ensuring compliance, service quality, staffing, training, budgeting, and profit-and-loss performance. Establishes policies, business plans, and performance goals; monitors management reports; supports sales and client service efforts; and leads hiring, employee development, performance management, and personnel policy administration. Requires strong claims knowledge, leadership, communication, analytical, organizational, negotiation, and interpersonal skills, along with substantial claims management and supervisory experience.

Provides clerical and administrative support for workers compensation claims staff. Responsibilities include entering new claims, updating notes, processing payments and mail, preparing correspondence and reports, scheduling medical appointments, answering calls, and providing customer service. The role requires strong organization, communication, computer skills, and the ability to manage multiple priorities in an in-office environment.