Workers Compensation Claims Examiner

Job Description

Job Description

Claims Examiner (Workers’ Compensation)

Position Summary

Our client is seeking an experienced Claims Examiner to independently manage a full-cycle caseload of workers’ compensation claim from inception through resolution. This role requires strong technical expertise, sound judgment, and the ability to handle highly complex indemnity claims within established authority limits.

This is a highly interactive role requiring regular communication with clients, claimants, attorneys, medical providers, and internal stakeholders. Consistent, reliable attendance and strong organizational discipline are essential to success.

Key Responsibilities

• Manage a caseload of 150–180 workers’ compensation claims , including complex indemnity cases

• Conduct timely and thorough investigations to determine claim compensability

• Administer benefits in accordance with state regulations and company guidelines

• Oversee medical treatment plans and authorize medical services and billing as appropriate

• Coordinate with and manage defense counsel on litigated claims

• Communicate effectively with claimants, providers, vendors, and clients regarding claim status and issues

• Establish and maintain appropriate claim reserves within authority guidelines

• Negotiate and finalize claim settlements within designated authority levels

• Maintain accurate and up-to-date claim documentation and diary systems

• Provide clients with timely updates, including injury trends and risk insights

• Conduct independent file reviews and ensure compliance with internal policies

• Perform additional duties as assigned

Qualifications

Education & Experience

• Bachelor’s degree in a related field (preferred)

• 5+ years of workers’ compensation claims experience or equivalent combination of education and experience

  Must have an active California SIP certification - Self Insurance Plans)

Knowledge, Skills & Abilities

• Strong knowledge of workers’ compensation laws and regulations

• Familiarity with medical terminology and claims processes

• Excellent analytical and problem-solving skills

• Strong written and verbal communication skills

• Ability to manage high-volume, complex caseloads independently

• Proficiency in Microsoft Office (Word, Excel preferred)

• Ability to collaborate effectively with stakeholders at all levels

Certifications

• Relevant state licenses and/or certifications as required

Work Environment & Physical Requirements

• Primarily office-based role requiring extended periods of sitting and computer use

• Frequent communication via phone and email

• Occasional light physical activity (lifting, reaching, etc.) consistent with a standard office environment

Why This Opportunity Stands Out

This is not an entry-level examiner role. If you’re used to handling basic claims, you’ll get exposed here. This role is built for someone who:

• Wants ownership of complex files

• Is confident making decisions within authority

• Can handle volume without sacrificing quality

If that’s you, this is a strong platform to grow and be recognized.