Senior Claims Examiner

Role Description

This is a remote position based in California, and candidates must reside within the state.

As a Senior Claims Examiner, you’ll play a vital role in helping businesses and individuals navigate complex Workers' Compensation claims. This is your opportunity to make a meaningful impact by resolving claims efficiently, mitigating risks, and delivering exceptional service.

In this role, you’ll manage Workers' Compensation indemnity claims, ensuring they’re handled with care and precision. You’ll oversee complex claim issues, leveraging your expertise in litigation management and lien resolution to achieve fair outcomes. Your day-to-day will involve:

• Maintaining accurate claim diaries
• Updating reserves
• Ensuring timely reporting to key stakeholders
• Collaborating with legal teams
• Identifying opportunities for subrogation
• Working closely with clients to maintain satisfaction

Additionally, you’ll:

• Prepare and attend file reviews to ensure claims are progressing effectively
• Negotiate settlements and resolve outstanding liens
• Monitor and guide defense attorneys to achieve optimal outcomes
• Ensure compliance with all regulatory requirements and deadlines

Qualifications

• High school diploma and 5 years related claims experience required
• Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements
• Extensive knowledge of accepted industry standards and practices
• Computer experience with related claims and business software
• Bachelor's degree preferred

Requirements

• Ability to think critically and solve problems
• Plan and organize activities
• Serve clients and negotiate
• Effectively communicate verbally and in writing
• Embrace new challenges
• Analytical skill necessary to make decisions and resolve complex issues inherent in handling losses
• Ability to successfully negotiate the settlement and disposition of serious claims
• Ability to interpret related documentation