Workers’ Compensation Claims Examiner

This position *****$32-$52 hourly DOE*****Hybrid Granite Bay, CA officesWorkers Comp Claims ExaminersYou are aWorkers Comp Claims Examiners. In this role you will manage a complex case load with exposures of greater severity including complex legal or medical issues; 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.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 legalManage 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 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 trialsHigh school diploma or G.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 reservesCommunicate effectively, patiently and courteously with employees, Board Members, patrons and other community members and be responsible for protection of patron confidentiality

Created: 2025-09-30