Senior Workers Compensation Claims Examiner

This is a fully remote position, open to applicants in California.

📋 Description

• Effectively oversee a caseload of California workers' compensation claims from initiation through to resolution.

• Conduct thorough investigations of claims, assess compensability, and determine suitable strategies for claim management.

• Review coverage, liability, medical documentation, and claim exposure in compliance with California regulations.

• Set and manage reserves based on claim exposure and ongoing developments.

• Handle complex indemnity claims, including litigated cases and settlement negotiations.

• Collaborate with defense counsel, medical providers, employers, and other stakeholders throughout the claims process.

• Track claim progress, maintain accurate records, and ensure timely follow-up on all assigned files.

• Coordinate return-to-work initiatives and promote positive claim outcomes.

• Recognize opportunities for fraud detection, subrogation, and cost containment when appropriate.

• Ensure complete, accurate, and timely documentation within the claims management system.

• Offer guidance and recommendations on complex claims as necessary.

• Undertake additional duties and projects as assigned.

⛳️ Requirements

• A minimum of 5 years of experience managing California workers' compensation claims is required.

• Experience in managing indemnity claims is essential.

• Proven experience handling litigated workers' compensation claims is necessary.

• A current California Adjuster Certification, OSIP/SIP self-insured qualification, or Certified Workers' Compensation Professional (CWCP) designation is required.

• In-depth knowledge of California workers' compensation laws, regulations, and claims handling practices is essential.

• Experience in developing claim resolution strategies and negotiating settlements is required.

• Capability to independently manage complex claims with minimal supervision.

• Strong analytical, decision-making, and problem-solving abilities.

• Excellent verbal and written communication skills.

• Strong organizational skills with the ability to handle multiple priorities in a remote setting.

• Proficiency in Microsoft Office and claims management systems is required.

🏝️ Benefits

• Comprehensive medical insurance.

• Dental insurance.

• Vision insurance.

• Life and disability insurance.

• Fertility benefits.

• Wellness resources.

• Paid sick time.

• Generous paid time off.

• Employee Assistance Program (EAP).

• Complimentary Calm app subscription.

• Immediate vesting in a 401(k) plan.

• HSA and FSA options.

• Commuter benefits.

• Employee discount programs.

• Paid maternity leave.

• Paid paternity leave.