Senior Workers’ Compensation Claims Examiner | CA experience

Insurance Placement Solutions (IPS) has an immediate opening for a Senior Workers’ Compensation Claims Examiner with our client in Sacramento, California. This is a full-time, temp-to-hire opportunity offering a hybrid or remote work arrangement. Candidates must have at least five years of workers’ compensation claims handling experience, including complex and litigated California indemnity claims, and a current California Self-Insurance Administrator (SIP) Certificate.

In this role, you’ll independently manage a senior-level caseload of complex California workers’ compensation indemnity claims from investigation through resolution. You’ll determine compensability, administer benefits, coordinate medical treatment, establish reserves, oversee litigation, and negotiate settlements while ensuring compliance with California workers’ compensation regulations and client requirements. You’ll also participate in claim reviews, identify recovery opportunities, and provide guidance to less experienced examiners.

Senior Workers’ Compensation Claims Examiner Responsibilities

• Manage a senior-level caseload of complex and litigated California workers’ compensation indemnity claims
• Conduct timely claim investigations and determine compensability in accordance with California workers’ compensation regulations
• Calculate and administer indemnity benefits within established authority and guidelines
• Coordinate medical treatment, review medical billing, and authorize services as appropriate
• Refer claims to defense counsel and actively manage litigated matters
• Evaluate claim exposure, establish appropriate reserves, and maintain accurate financial documentation
• Develop claim action plans and negotiate settlements within designated authority
• Identify potential apportionment opportunities and coordinate appropriate claim evaluations
• Investigate subrogation potential and pursue applicable recoveries
• Identify claims requiring excess reporting and reimbursement consideration
• Communicate claim developments with claimants, clients, attorneys, medical providers, and vendors
• Maintain accurate claim documentation, diary management, and timely action plans
• Participate in client claim reviews, state audits, and regulatory reporting activities
• Mentor less experienced claims examiners and provide guidance on complex claim matters
• Handle additional workers’ compensation jurisdictions as assigned

Qualifications

• Minimum of 5 years of workers’ compensation claims handling experience
• Experience independently managing complex and litigated California workers’ compensation indemnity claims
• Strong knowledge of California workers’ compensation laws, regulations, and benefit administration requirements
• Experience managing litigation, claim reserves, settlements, and medical treatment coordination
• Ability to independently evaluate complex claims and develop effective resolution strategies
• Strong analytical, organizational, and problem-solving skills
• Excellent written and verbal communication skills
• Ability to manage competing priorities and maintain accurate claim documentation

Preferred

• Experience mentoring or providing technical guidance to less experienced claims examiners
• Experience identifying subrogation, apportionment, and excess recovery opportunities
• Proficiency with Microsoft Word and Excel

Licensing & Certifications

• Current California Self-Insurance Administrator (SIP) Certificate required
• Additional adjuster licenses as required by assigned jurisdictions

Work Arrangement

• Full-time, temp-to-hire opportunity
• Hybrid or remote work arrangement

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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