Job Title : Claims Examiner - Workers Compensation

Location : Remote (CA)

Target Start Date: 06/09/2025

Duration : 03+ Months of Contact

Job description:

Primary Purpose:

The Workers' Compensation Claims Examiner will analyze complex and technically difficult workers' compensation claims to determine benefits due. This role involves handling high-exposure claims with potential litigation and rehabilitation needs, ensuring claims are adjudicated within service expectations, industry best practices, and specific client requirements. The Examiner will also identify opportunities for subrogation and negotiate settlements.

Essential Functions and Responsibilities:

• Analyze and manage complex workers' compensation claims from investigation through resolution.
• Develop and execute effective action plans for timely and appropriate claim outcomes.
• Negotiate claim settlements within designated authority levels.
• Calculate, assign, and maintain appropriate claim reserves.
• Process and approve timely benefit payments and necessary adjustments.
• Prepare and submit all required state filings within statutory timeframes.
• Manage litigation processes, coordinating legal strategies for cost-effective resolution.
• Utilize cost containment strategies, including partnerships with vendors.
• Pursue claim recoveries, such as subrogation and Second Injury Fund recoveries.
• Communicate claim activity and developments with claimants and clients.
• Maintain accurate claim documentation and ensure correct claims coding.
• Escalate cases to supervisors or management when necessary.
• Support and uphold the organization’s quality programs.

Additional Functions:

• Perform other duties as assigned.

Qualifications:

Education & Licensing:

• Bachelor’s degree preferred.
• Professional certification (such as California SIP) is preferred but not mandatory.

Experience:

• Minimum 3 years of California workers' compensation claims experience (required).
• At least 5 years of overall claims management experience or equivalent education/experience.

Skills & Knowledge:

• Strong knowledge of California workers' compensation laws, insurance principles, recoveries, and medical management.
• Excellent oral and written communication and presentation skills.
• Proficient with Microsoft Office and general PC literacy.
• Strong analytical, interpretive, and organizational skills.
• Good interpersonal and excellent negotiation skills.
• Ability to thrive in a team environment and meet or exceed service expectations.
• Ability to manage multiple priorities under stress and meet deadlines.

Thanks,