Worker Compensation Claims Examiner III (Hybrid)

Worker Compensation Claims Examiner III (Hybrid)

Schedule: Full-Time, 8am to 5pm

Position Overview

This role is responsible for managing complex and litigated workers' compensation indemnity claims from assignment through resolution. The Claims Examiner III works closely with claimants, attorneys, medical providers, nurse case managers, vocational experts, vendors, clients, and internal staff to ensure claims are handled in compliance with state regulations and company best practices.

Key Responsibilities

Manage a caseload of complex and litigated workers' compensation claims.

Investigate claims and determine compensability.

Administer benefits according to applicable state laws.

Authorize and manage medical treatment and medical billing.

Coordinate with defense counsel on litigated claims.

Set and maintain claim reserves.

Negotiate settlements and obtain appropriate authority approvals.

Maintain detailed claim documentation and diary management.

Communicate with clients regarding claim status, trends, and safety concerns.

Identify subrogation opportunities and pursue recoveries.

Handle excess reporting and reimbursement matters.

Assist with state audits and regulatory reporting.

Mentor junior claims examiners.

Required Qualifications

Experience

Minimum of 5 years of workers' compensation claims experience.

Proven ability to manage highly complex and litigated claims independently.

SIP experience require

Knowledge & Skills

Strong understanding of workers' compensation laws and regulations.

Knowledge of medical terminology.

Excellent analytical, written, and verbal communication skills.

Ability to work effectively with attorneys, claimants, clients, and medical professionals.

Proficiency with Microsoft Word and Excel preferred.

Licensing

Appropriate workers' compensation claims licenses/certifications as required by the jurisdiction.

Ideal Candidate Profile

The strongest candidates will have:

Significant California workers' compensation claims experience.

Experience handling litigated indemnity claims.

Reserve-setting and settlement authority experience.

Strong client-facing communication skills.

Experience mentoring or training other claims professionals.

Knowledge of subrogation, apportionment, state audits, and excess reporting.

Benefits

Medical, Dental, and Vision Insurance

Life and Disability Insurance

401(k)

Paid Holidays

Paid Time Off

Employee Referral Bonus

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, Los Angeles County Fair Chance Ordinance, and San Francisco Fair Chance Ordinance.