Job Description

Job Title: Claims Examiner - Workers Compensation
Location (On-site, Remote, or Hybrid?): Orange, CA (Remote)
Contract Duration: Contract until 12/31/2026

PRIMARY PURPOSE OF THE ROLE
To analyze complex or technically difficult California workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Education :

• Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
• Experience: Four (4) years of California workers compensation claims management experience or equivalent combination of education and experience required.

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