Workers' Compensation Claims Examiner

Accountabilities:

- Claims Management: Manage a full caseload of California workers' compensation claims from initial notification through investigation, administration, negotiation, and final resolution.

- Investigation and Compensability: Investigate claims, assess available evidence, determine compensability, and establish appropriate reserves based on claim circumstances and potential exposure.

- Claim Strategy and Resolution: Develop and implement effective claim handling strategies, monitor case progress, and identify appropriate approaches to achieve timely and fair resolutions.

- Stakeholder Coordination: Maintain regular communication and coordinate with injured workers, employers, attorneys, medical providers, vocational professionals, and other relevant parties throughout the life of each claim.

- Medical and Financial Evaluation: Review medical records, wage information, and supporting documentation to assess claim exposure, determine eligibility, and evaluate appropriate benefits.

- Settlement Negotiation and Litigation: Negotiate settlements and collaborate with defense counsel on litigated claims, supporting effective case management and resolution.

- Documentation and Systems Management: Maintain complete, accurate, and timely claim records within the claims management system, ensuring all relevant activities and decisions are properly documented.

- Regulatory Compliance: Ensure all claim handling activities comply with California workers' compensation statutes, regulations, benefit requirements, and applicable internal guidelines.

Requirements:

- Professional Experience: At least five years of experience as a California Workers' Compensation Claims Examiner is required.

- California Regulatory Knowledge: Strong understanding of California workers' compensation laws, regulations, claims procedures, and benefit administration.

- Claims Expertise: Demonstrated experience managing indemnity claims and litigated California workers' compensation cases from inception through resolution.

- Residency: Must currently reside in California.

- Investigation and Analytical Skills: Ability to evaluate medical records, wage documentation, legal materials, and other evidence to determine compensability and assess claim exposure.

- Negotiation Skills: Experience negotiating settlements and working effectively with defense counsel and other stakeholders on complex or litigated claims.

- Communication and Relationship Management: Excellent written and verbal communication skills, with the ability to interact professionally with injured workers, employers, attorneys, medical providers, and other parties.

- Organization and Time Management: Strong organizational skills and the ability to prioritize competing deadlines while maintaining accurate documentation and managing a full caseload.

- Independent Working Style: Ability to work autonomously, exercise sound judgment, and maintain productivity in a fully remote environment.

- Technical Proficiency: Experience using claims management systems and proficiency with Microsoft Office applications.

- Certification: SIP certification is preferred but not required.

Benefits:

- Compensation: $45–$55 per hour, depending on experience.

- Work Arrangement: Fully remote position.

- Healthcare Coverage: Medical, dental, and vision benefits available while on assignment.

- Retirement: 401(k) benefits available while on assignment.

- Employment Opportunity: Temporary-to-permanent arrangement, with a strong opportunity for permanent employment based on performance.

How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
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