Workers Compensation Claims Examiner

Job Description

Job Description

Job Profile

Job Title: Claims Examiner

Location: Onsite/Hybrid (Rancho Cucamonga) CA

Hire Type: Contingent

Pay Range: $70/hr.

Work Model: Onsite/Hybrid (Rancho Cucamonga) CA

Work Shift: Monday-Friday 8 am – 4 pm

Recruiter Contact: Sean Craft I View email address on ziprecruiter.com I View phone number on ziprecruiter.com

Nature & Scope:

Positional Overview

Imagine Staffing is seeking an experienced Workers' Compensation Claims Examiner to manage complex California workers' compensation claims, including lost-time claims, litigation matters, and high-exposure cases. The ideal candidate will have strong knowledge of California workers' compensation regulations, excellent analytical abilities, and experience driving claims to timely and cost-effective resolution.

This role is available as onsite/hybrid for candidates residing within 25 miles of the Rancho Cucamonga office or fully remote for candidates located within California .

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Role & Responsibility:

Tasks That Will Lead to Your Success

• Analyze and manage complex workers' compensation claims from inception through closure.
• Investigate claims by gathering medical, legal, and employment-related information to determine compensability and exposure.
• Develop and execute strategic action plans to ensure timely and appropriate claim resolution.
• Calculate and establish accurate claim reserves and maintain reserve adequacy throughout the life of the claim.
• Authorize and process indemnity and medical benefit payments in accordance with state regulations and company guidelines.
• Negotiate settlements within designated authority levels.
• Manage litigated claims and coordinate with defense attorneys, medical providers, and vocational rehabilitation professionals.
• Prepare and submit required state filings within statutory deadlines.
• Identify and pursue subrogation opportunities and other recovery options.
• Coordinate vendor referrals for investigations, medical reviews, surveillance, and litigation support as needed.
• Implement cost-containment strategies to reduce overall claim expenses while maintaining quality outcomes.
• Report applicable claims to excess carriers and respond to requests in a timely and professional manner.
• Maintain accurate claim documentation and ensure proper claims coding.
• Communicate effectively with claimants, attorneys, employers, clients, and internal stakeholders.
• Refer complex issues to management when appropriate.
• Support organizational quality initiatives and perform additional duties as assigned.

Skills & Experience

Qualifications That Will Help You Thrive

• Self-Insured Plans (SIP) Certification is required.
• Minimum of 3 years of recent workers' compensation claims handling experience.
• Experience handling California lost-time workers' compensation claims.
• Strong understanding of California workers' compensation laws, regulations, and claims procedures.
• Experience managing litigated claims and working with defense counsel.
• Ability to analyze claim exposure and make sound claim decisions.
• Strong negotiation and settlement skills.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office applications and claims management systems.
• Strong organizational, analytical, and problem-solving abilities.
• Ability to manage multiple priorities in a fast-paced environment.
• Expertise in workers' compensation claims administration
• Litigation management
• Reserve analysis and management
• Cost containment strategies
• Medical management practices
• Subrogation and recovery processes
• Excellent customer service and client relationship management
• Strong attention to detail and organizational skills
• Ability to work independently and collaboratively within a team environment

Preferred Qualifications

• Bachelor's degree from an accredited college or university.
• Professional claims-related certifications.
• Five (5) years of workers' compensation claims management experience.
• Experience handling high-exposure and complex indemnity claims.

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