Claims Examiner – Workers Compensation, CA Jurisdiction

This is a fully remote position, open to applicants in Arizona, +5 more states.

📋 Description

• Evaluate and manage intricate or technically challenging California workers' compensation claims.

• Conduct thorough investigations and gather necessary information to assess claim exposure.

• Oversee claims using action plans to ensure timely and appropriate resolutions.

• Negotiate settlements within assigned authority limits.

• Calculate and allocate timely and appropriate reserves.

• Monitor reserve adequacy throughout the duration of the claims.

• Determine and disburse benefits as required.

• Approve and execute timely claim payments and adjustments.

• Resolve claims within the designated authority level.

• Prepare essential state filings in accordance with statutory requirements.

• Manage litigation processes to achieve timely and cost-effective claim resolutions.

• Report claims to the excess carrier.

• Address requests for direction in a professional and prompt manner.

• Identify subrogation claims and engage in settlement negotiations.

⛳️ Requirements

• Experience with California workers' compensation claims is essential.

• Proven track record in managing litigated and high-exposure claims.

• A minimum of four (4) years of experience in California workers' compensation claims management or an equivalent combination of education and experience is required.

• Knowledge of California jurisdictional regulations is mandatory.

• SIP certification is required or must be obtained within one year of employment.

• A bachelor's degree from an accredited college or university is preferred.

• Professional certification relevant to the line of business is preferred.

• Strong investigative skills to determine claim exposure are necessary.

• Capability to manage claims through investigation, benefit determination, negotiation, and resolution.

• Proficient in calculating and assigning reserves.

• Competent in calculating, disbursing benefits, and making claim payments and adjustments.

• Ability to prepare necessary state filings in compliance with statutory limits.

• Skilled in managing litigation processes.

• Experience in reporting claims to excess carriers and responding to direction requests.

• Strong analytical and conceptual thinking abilities.

• Excellent judgment, troubleshooting, problem-solving, and discretion skills.

• Ability to handle work-related stress and manage multiple priorities simultaneously.

• Capacity to meet deadlines consistently.

• Proficient in computer keyboarding.

• Adequate hearing, vision, and verbal communication skills.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and advancement.

• Comprehensive medical, dental, and vision insurance.

• 401K plan with matching contributions.

• Paid time off (PTO).

• Disability and life insurance coverage.

• Employee assistance programs.

• Options for flexible spending or health savings accounts.

• Additional voluntary benefits available.

• Flexibility and autonomy in daily work, location, and career trajectory.

• Opportunities for professional development.