Workers Compensation Claims Examiner

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

📋 Description

• Oversee a portfolio of California workers’ compensation claims from the point of initial assignment to final resolution.

• Assess and analyze coverage, liability, and compensability in compliance with California Labor Code and regulatory standards.

• Perform comprehensive investigations, which include collecting statements, reviewing documentation, and analyzing claim reports.

• Establish and manage reserves based on risk exposure and developments in the claims.

• Ensure timely and precise disbursement of benefits and necessary communications.

• Maintain claim diaries and guarantee consistent follow-up throughout the claim’s lifecycle.

• Facilitate return-to-work initiatives and monitor ongoing claim activities.

• Supervise litigation processes, collaborating with defense attorneys and engaging in claim strategy discussions.

• Negotiate settlements within the designated authority and offer recommendations on cases that exceed that authority.

• Detect potential fraud, subrogation opportunities, and strategies for cost containment.

• Maintain precise and compliant documentation within the claims management system.

• Communicate effectively with injured workers, employers, medical providers, attorneys, and internal stakeholders.

⛳️ Requirements

• A minimum of 3 years of experience in managing workers’ compensation claims is required.

• Must possess an active California Adjuster License, experience with self-insured claims programs (OSIP or SIP), or hold a Certified Workers’ Compensation Professional (CWCP) designation.

• In-depth knowledge of California workers’ compensation legislation and claims handling procedures.

• Experience in managing indemnity claims, litigation, and claim resolution strategies.

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

• Exceptional verbal and written communication skills.

• Strong organizational capabilities and the ability to handle multiple claims simultaneously.

• Ability to work independently in a remote environment.

• Proficiency in Microsoft Office and claims management systems.

🏝️ Benefits

• Extensive medical insurance coverage.

• Dental insurance.

• Vision insurance.

• Life and disability insurance.

• Fertility benefits.

• Access to wellness resources.

• Paid sick leave.

• Generous paid time off and holiday benefits.

• Employee Assistance Program (EAP).

• Free subscription to the Calm app.

• Immediate vesting in a 401(k) retirement plan.

• Options for Health Savings Account (HSA) and Flexible Spending Account (FSA).

• Commuter benefits.

• Employee discount programs.

• Paid maternity and paternity leave (including for adoptive parents).

• Options for legal plans.

• Coverage for pet insurance.