Workers Compensation Claims Examiner Brea

Job Description

Job Description

Job Profile

Job Title: Claims Examiner

Location: Remote

Hire Type: Contingent

Pay Range: $67/hr.

Work Model: Remote

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

We are actively seeking an experienced Workers Compensation Claims Examiner to analyze and process complex workers’ compensation claims, ensuring accurate determination of benefits due and timely resolution. The role focuses on high-exposure claims that may involve litigation and rehabilitation, with a strong emphasis on maintaining industry best practices, effective communication with claimants and clients, and identifying subrogation opportunities for cost recovery.

Role & Responsibility:

Tasks That Will Lead to Your Success

• Analyze, investigate, and manage complex workers’ compensation claims to determine benefit entitlement and claim exposure.
• Develop and implement strategic action plans for a timely and appropriate claim resolution.
• Calculate and assign accurate reserves; adjust reserves as appropriate throughout the claim lifecycle.
• Process and issue benefit payments in accordance with applicable laws and within designated authority.
• Prepare and file all required state documentation within statutory deadlines.
• Handle litigated claims; coordinate with legal counsel and manage the litigation process for optimal outcomes.
• Refer and coordinate with vendors for investigations, medical evaluations, or legal support as necessary.
• Employ cost containment strategies and leverage vendor partnerships to minimize claim costs.
• Manage subrogation efforts and other recovery opportunities, including Second Injury Fund and Social Security/Medicare offsets.
• Report applicable claims to excess carriers and follow through with necessary updates.
• Maintain regular communication with claimants, employers, and clients to ensure transparent and professional claims experience.
• Maintain accurate, up-to-date documentation and ensure all claim coding meets regulatory and internal standards.
• Escalate claims to supervisors when appropriate.

Skills & Experience

Qualifications That Will Help You Thrive

• High school diploma or GED
• Minimum of 5 years of California workers’ compensation claims handling experience
• SIP Certification (Self-Insurance Plan) – Mandatory
• Comprehensive knowledge of California workers' compensation laws, rules, and medical management practices
• Excellent written and verbal communication skills
• Proficiency in Microsoft Office Suite and electronic claims systems
• Strong analytical, negotiation, and organizational abilities
• Professional interpersonal skills and the ability to work effectively in a team environment
• Self-motivated and capable of managing high-volume caseloads while meeting service expectations and deadlines
• Remote within California – candidates must reside in and work from within the state.