Workers’ Compensation Claims Examiner

Insurance Placement Solutions (IPS) has an immediate opening for a Workers’ Compensation Claims Examiner with our client. This opportunity is available to candidates located in California, with remote, hybrid, or onsite arrangements based on proximity to a local office.

In this role, you’ll manage California lost-time workers’ compensation claims, including complex and high-exposure files involving litigation and rehabilitation. You’ll investigate and evaluate claims, administer benefits, establish reserves, manage litigation, negotiate settlements, and identify recovery opportunities while ensuring compliance with California workers’ compensation requirements.

Workers’ Compensation Claims Examiner Responsibilities

Analyze and process complex California workers’ compensation claims

Investigate claims and gather information to determine compensability and exposure

Manage lost time claims through well-developed action plans and timely resolution

Establish and maintain appropriate reserves throughout the life of the claim

Calculate and administer workers’ compensation benefits

Negotiate settlements within designated authority

Manage litigated claims and coordinate with defense counsel and other vendors

Coordinate medical management and rehabilitation activities

Utilize appropriate cost-containment strategies to manage claim costs

Identify and pursue subrogation and other recovery opportunities

Manage applicable Second Injury Fund, Social Security, and Medicare offsets

Report applicable claims to excess carriers

Communicate claim activity and developments with claimants and clients

Maintain accurate and timely claim documentation and coding

Ensure claims are handled in accordance with California requirements, industry best practices, and client service expectations

Qualifications

Minimum of 3 years of recent California workers’ compensation claims experience

Strong lost time/indemnity workers’ compensation claims experience

Experience handling complex or high-exposure claims

Experience managing workers’ compensation claims involving litigation

Preferred

Experience handling California Education Code (Ed Code) workers’ compensation claims

Bachelor’s degree from an accredited college or university

Professional insurance or claims designation

Licensing & Certifications

California SIP certificate required

About Insurance Placement Solutions

Insurance Placement Solutions is a staffing and recruiting firm specializing in the insurance industry. We connect talented professionals with temporary, temp-to-hire, and direct-hire opportunities at leading insurance organizations across the United States.

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