Workers' Compensation Claims Examiner

This position pays: $32-$52 hourly DOELocation: Hybrid Granite Bay, CA officesWorkers Comp Claims Examiners You are a Workers Comp Claims Examiners. In this role you will manage a complex case load with exposures of greater severity including complex legal or medical issues; have a greater reserve and settlement authority, within client restrictions; and uses independent decision making in finding solutions critical for moving claims toward resolution, offering suggestion for improvement and implementing approved solutions. Claims files reflect a lower level of legal involvement and, when counsel is necessary, the Senior Claims Examiner takes on an active role in the litigation process, directing counsel, rather than passively accepting recommendations of counsel.What you will be doing:Evaluate claim and determine course of action from inception to resolution timely and accuratelyGather and analyze information including medical, legal, and factual evidence to determine compensability of claimEvaluate claim to determine appropriate use of independent medical evaluations for claims and/or refer to legalEvaluate all information to make appropriate independent determination on compensability and issue compensability decisionsManage and direct action of diary, e-mail, mail, faxes, phone calls, payments, required benefit notices, etc. to move claim to the best financial outcome and timely resolutionEvaluate and establish medical, legal, vocational rehabilitation, and indemnity reserves based on facts of case and full potential exposure including reporting to excess carrier within authority levelEvaluate and determine an appropriate negotiated settlement amount, within authority levelCommunicate, strategize and direct legal counsel regarding issues such as discovery, depositions, settlement valueProvide superior claims processing and diary management as exhibited by appropriate reserves, timely payments, reports, contacts, closings and activity on the claim filesActively participate in the professional development of other team members by sharing knowledge and best practices through informal and formal trainingRepresent the company as needed in depositions, conferences, hearings and trialsAll other duties as assigned or as situation dictatesWhat you bring:High school diploma or G.E.D. required; Bachelor's degree preferredMinimum five (5) years' experience as a workers' compensation examiner requiredStrong knowledge of claims management techniques, including investigation, reserving, cost analysis and case resolution techniquesStrong customer focus with a strong sense of urgency and attention to detailExcellent organization skills and demonstrated experience managing multiple simultaneous projectsOrganizational and time management skills related to project managementProficient with Microsoft Office and be able to learn and implement specialty software systems and proceduresAnalyze a variety of information to maximize cost-effective claim managementDiscuss claim issues and justify claim reservesAnticipate problems and evaluate information to develop and evaluate options and implement solutionsCommunicate effectively, patiently and courteously with employees, Board Members, patrons and other community members and be responsible for protection of patron confidentialityRecognize insufficient reserve situations and bring to management's attention timelyManage multiple activities or interruptions at once and to work positively and effectively within a team or self-directed modelCertificate or other Licenses:SIP License preferred (senior-level)To learn more about the workplace culture and the position, apply today!

Created: 2025-09-18