Workers Compensation Claims Examiner, CA Jurisdiction

This is a fully remote position, open to applicants in Arizona, +8 more states.

📋 Description

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

• Conduct investigations and collect information to assess claim exposure.

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

• Negotiate claim settlements within established authority limits.

• Calculate and assign appropriate reserves promptly, ensuring reserve adequacy throughout the lifecycle of the claim.

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

• Resolve claims within the specified authority level.

• Prepare necessary state filings in accordance with statutory requirements.

• Manage the litigation process to guarantee timely and cost-effective claims resolutions.

• Report claims to the excess carrier and respond to direction requests in a professional and prompt manner.

• Identify opportunities for subrogation and negotiate settlements.

⛳️ Requirements

• Experience handling California workers' compensation claims.

• Minimum of three (3) years in California workers' compensation claims management or a suitable combination of education and experience.

• Knowledge of California jurisdictional regulations is essential.

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

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

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

• Experience with litigated and high-exposure claims is required.

• Understanding of California jurisdictional standards.

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

• Strong analytical and conceptual thinking skills; excellent judgment, problem-solving, and discretion.

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

• Competence in meeting deadlines.

• Proficiency in computer keyboarding.

• Ability to hear, see, and communicate effectively.

• Work authorization in the United States is implied for candidates eligible for U.S.-based positions.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and advancement.

• Medical, dental, and vision insurance.

• 401(k) with matching contributions.

• Paid time off (PTO).

• Disability and life insurance.

• Employee assistance program.

• Flexible spending or health savings account options.

• Additional voluntary benefits.

• Remote work or work-at-home arrangements.