Workers Compensation Claims Examiner

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

📋 Description

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

• Investigate and collect information to assess claim exposure.

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

• Negotiate claim settlements within assigned authority limits.

• Calculate and allocate timely and suitable reserves.

• Monitor reserve adequacy throughout the duration of claims.

• Determine and disburse benefits owed; authorize and execute claim payments and adjustments.

• Finalize claims within designated authority thresholds.

• Prepare essential state filings within statutory timeframes.

• Oversee the litigation process and ensure efficient, cost-effective claims resolution.

• Report claims to the excess carrier and address requests for guidance.

• Identify subrogation opportunities and negotiate settlements.

⛳️ Requirements

• Bachelor's degree from an accredited institution preferred.

• Professional certification relevant to the line of business preferred.

• 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 jurisdiction is essential.

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

• Experience in managing litigated and high-exposure claims.

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

• Strong analytical and conceptual thinking skills.

• Excellent judgment, problem-solving abilities, and discretion.

• Ability to manage work-related stress and prioritize multiple tasks simultaneously.

• Ability to meet deadlines effectively.

• Proficiency in keyboarding.

• Capable of hearing, seeing, and speaking.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and promotional growth.

• Medical, dental, and vision coverage.

• 401(k) plan with matching contributions.

• Paid time off (PTO).

• Disability and life insurance.

• Employee assistance program.

• Flexible spending account or health savings account.

• Additional voluntary benefits available.

• Reasonable accommodations provided when applicable and appropriate.