Workers Compensation Claims Examiner CA

Job Description

Job Description

Job Profile

Job Title: Claims Examiner

Location: Orange, CA -must live in CA

Hire Type: Contingent

Pay Range: $72

Work Model: Remote/Onsite

Work Shift: Monday-Friday 8 am – 4:30 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 support a leading national claims management organization. This role is responsible for managing complex California workers' compensation claims from investigation through resolution while ensuring compliance with state regulations, client expectations, and industry best practices.

Please Note:

• Only former Sedgwick employees will be considered.
• Position is available remote within California or onsite in Orange, CA.
• California Workers' Compensation Adjuster Certification is required.
• Minimum 3 years of recent California Workers' Compensation claims experience required.

Role & Responsibility:

Tasks That Will Lead to Your Success

• Manage a caseload of complex California workers' compensation claims from inception through closure.
• Investigate claims to determine compensability, liability, and benefit eligibility.
• Develop strategic action plans to drive timely and appropriate claim resolution.
• Establish, monitor, and adjust claim reserves throughout the life of each claim.
• Calculate and issue indemnity and medical benefit payments accurately and within statutory guidelines.
• Negotiate settlements within assigned authority while maintaining cost-effective claim outcomes.
• Manage litigated claims by coordinating with defense counsel, medical providers, and other vendors.
• Prepare and file all required California workers' compensation documentation within regulatory deadlines.
• Identify subrogation opportunities and pursue available recoveries when applicable.
• Coordinate investigations, independent medical evaluations (IMEs), surveillance, and additional vendor services as needed.
• Communicate professionally with injured workers, employers, attorneys, medical providers, and clients regarding claim activity and status.
• Maintain accurate electronic claim files, documentation, and coding.
• Escalate complex issues to management when appropriate.
• Support quality assurance initiatives and perform additional duties as assigned

Skills & Experience

Qualifications That Will Help You Thrive

• California Workers' Compensation Adjuster Certification.
• Former Sedgwick employee (required).
• Minimum 3 years of recent California workers' compensation claims experience.
• Strong experience handling complex and litigated workers' compensation claims.
• Thorough understanding of California workers' compensation laws, regulations, and claims administration.
• Experience managing reserves, settlements, litigation, and claim recoveries.

Preferred

• Bachelor's degree from an accredited college or university.
• Professional claims certifications.

Skills & Experience

• Extensive knowledge of California workers' compensation claims handling practices.
• Strong understanding of insurance principles, litigation management, and cost containment strategies.
• Excellent analytical, investigative, and decision-making skills.
• Outstanding written and verbal communication skills.
• Strong negotiation and conflict-resolution abilities.
• Proficiency with Microsoft Office and electronic claims management systems.
• Highly organized with the ability to manage multiple priorities in a fast-paced environment.
• Ability to work independently while collaborating effectively with clients and internal teams.