Our client is currently seeking a Claims Examiner - Workers Compensation

Workers’ Compensation Claims Examiner (California WC)

Location: Remote (California only)
Experience: 5+ years
Certification: SIP Certification required

About the Role

Our client is seeking an experienced Workers’ Compensation Claims Examiner to manage California workers’ compensation claims independently. This role requires strong technical expertise, excellent communication skills, and the ability to deliver high‑quality claims resolution while meeting service expectations.

Key Responsibilities

• Manage a full caseload of California workers’ compensation claims from inception through resolution
• Evaluate coverage, liability, compensability, and benefits in compliance with California WC regulations
• Apply cost containment strategies, including medical management practices
• Coordinate with medical providers, attorneys, employers, and injured workers
• Identify and pursue recoveries, offsets, and deductions as applicable
• Ensure proper application of disability duration, Social Security, and Medicare considerations
• Negotiate settlements and recommend appropriate claim resolution strategies
• Maintain accurate and timely documentation within claims systems
• Meet or exceed service level and performance expectations
• Collaborate effectively within a team‑based environment

Required Qualifications

Education & Certification

• Bachelor’s degree from an accredited college or university preferred
• SIP (Self‑Insurance Plans) Certification required
• Professional claims certification preferred

Experience

• Minimum of five (5) years of California workers’ compensation claims adjusting experience
• Equivalent combination of education and experience may be considered

Skills & Knowledge

• Expert knowledge of California workers’ compensation laws and insurance principles
• Strong understanding of claim duration, disability management, and cost containment
• Experience with Social Security and Medicare application procedures
• Excellent written and verbal communication skills
• Strong analytical, organizational, and negotiation skills
• Proficient with Microsoft Office and claims management systems
• Ability to manage multiple priorities and work independently in a remote environment
• Strong interpersonal and teamwork skills

Work Environment

• Fully remote position (California residents only)

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