Claims Examiner - Workers' Compensation

Location: Remote or Onsite (California)
Duration: Contract (3+ Months)

About the Role

Our client is seeking an experienced Workers' Compensation Claims Examiner to join their team. In this role, you will be responsible for managing complex California workers' compensation claims, ensuring timely and accurate claim adjudication, maintaining compliance with state regulations, and delivering exceptional service to clients and claimants.

The ideal candidate will have strong experience handling litigated and high-exposure workers' compensation claims, along with an active California Adjuster Certification.

Key Responsibilities

• Investigate, evaluate, and manage complex workers' compensation claims from inception through resolution.
• Analyze claim exposure and develop effective action plans to achieve timely claim closure.
• Establish, monitor, and adjust claim reserves throughout the life of the claim.
• Calculate and process indemnity and medical benefits in accordance with California workers' compensation laws.
• Negotiate settlements within assigned authority limits.
• Manage litigated claims and coordinate with attorneys, vendors, and rehabilitation professionals as needed.
• Prepare and file all required state forms and documentation within statutory timeframes.
• Identify and pursue subrogation opportunities and other recovery options, including Social Security, Medicare offsets, and Second Injury Fund recoveries.
• Communicate claim status and developments with claimants, employers, clients, and internal stakeholders.
• Utilize cost-containment strategies and vendor partnerships to effectively manage claim expenses.
• Ensure claim files are accurately documented and maintained in accordance with company and regulatory standards.
• Escalate complex issues to management as appropriate.

Required Qualifications

• Active California Adjuster Certification.
• Minimum 3 years of Workers' Compensation Claims Examiner experience.
• Experience handling California workers' compensation claims.
• Strong knowledge of claim investigation, litigation management, reserve analysis, and settlement negotiations.
• Understanding of California workers' compensation statutes and regulatory requirements.
• Excellent analytical, organizational, and communication skills.
• Ability to manage a high-volume caseload independently.

Preferred Qualifications

• Experience handling complex, litigated, and high-exposure claims.
• Knowledge of subrogation and recovery processes.
• Experience working with attorneys, medical providers, and rehabilitation vendors.
• Strong customer service and client relationship management skills.

Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements.

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