Workers Compensation Claims Examiner

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

📋 Description

• Evaluate intricate or technically challenging California workers' compensation claims to ascertain due benefits.

• Conduct investigations and gather relevant information to assess claim exposure.

• Oversee claims through action plans to achieve timely and appropriate resolutions.

• Negotiate claim settlements within the established authority.

• Calculate and assign timely and appropriate reserves.

• Ensure reserve adequacy throughout the duration of claims.

• Calculate and disburse benefits owed; approve and execute timely claim payments and adjustments.

• Settle claims within the specified authority level.

• Prepare necessary state filings in compliance with statutory limits.

• Manage litigation processes to ensure timely and cost-effective resolution of claims.

• Report claims to the excess carrier and respond to direction requests.

• Identify subrogation opportunities and negotiate settlements.

• Provide customer-facing solutions and collaborate with clients and global experts.

⛳️ Requirements

• Experience in California workers' compensation.

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

• Proficiency in handling litigated and high-exposure claims.

• Knowledge of California jurisdictional requirements.

• Experience managing claims through the processes of investigation, benefit determination, settlement negotiation, and resolution.

• Bachelor's degree from an accredited institution is preferred.

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

• Required knowledge of California jurisdiction.

• SIP certification is required or must be obtained within one year of the hire date.

• Capability to analyze complex or technically challenging workers' compensation claims.

• Ability to investigate and compile claim exposure data.

• Proficient in calculating and assigning reserves and benefits.

• Skilled in managing litigation processes.

• Competent in preparing necessary state filings within statutory limits.

• Strong analytical and conceptual thinking abilities.

• Exceptional judgment, problem-solving, analysis, and discretion.

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

• Ability to meet deadlines effectively.

• Proficient in computer keyboarding, with good hearing, vision, and verbal communication skills.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and advancement.

• Comprehensive medical, dental, and vision coverage.

• 401(k) plan with matching contributions.

• Paid time off (PTO).

• Disability and life insurance coverage.

• Employee assistance program.

• Flexible spending account or health savings account options.

• Additional voluntary benefits available.

• Flexible location and autonomy in daily work.