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 Brea, California. This is a temporary opportunity for an experienced claims professional with four to eight years of claims handling experience, including complex workers’ compensation claims, coverage evaluation, litigation management, and settlement negotiations. Candidates must hold an active workers’ compensation adjuster license as required by the applicable jurisdiction.

In this role, you’ll independently manage complex workers’ compensation claims from investigation through resolution. You’ll evaluate coverage, direct claim investigations, coordinate litigation strategies with defense counsel, establish reserves, negotiate settlements, and identify recovery opportunities while ensuring timely claim resolution and compliance with applicable regulations and client requirements.

Senior Workers’ Compensation Claims Examiner Responsibilities

• Independently manage complex and unusual workers’ compensation claims from assignment through resolution
• Interpret policy provisions and determine coverage applicability for assigned claims
• Conduct and oversee comprehensive claim investigations to evaluate compensability, liability, and exposure
• Develop and direct litigation and discovery strategies in coordination with defense counsel
• Evaluate claim developments and establish appropriate reserves using independent judgment
• Authorize claim payments and settlements within designated authority limits
• Negotiate timely and cost-effective claim resolutions
• Identify potential subrogation and third-party recovery opportunities and pursue applicable recoveries
• Analyze claim activity, financial exposure, and resolution strategies
• Prepare claim reports and updates for clients, carriers, and management
• Participate in claim reviews and communicate recommendations to appropriate stakeholders
• Maintain accurate claim documentation and ensure timely processing of claim payments
• Manage competing priorities and ensure compliance with applicable claims-handling standards and regulatory requirements

Qualifications

• 4 to 8 years of claims handling experience within a workers’ compensation or similar claims organization
• Experience independently managing complex workers’ compensation claims
• Strong knowledge of claim investigations, coverage evaluation, reserving, litigation management, and settlement practices
• Experience coordinating litigation strategies with defense counsel
• Ability to analyze complex claim information and make sound decisions independently
• Strong negotiation, analytical, and problem-solving skills
• Excellent written and verbal communication and presentation skills
• Ability to manage multiple priorities and meet established deadlines
• Bachelor’s degree or equivalent professional experience

Preferred

• Professional designation such as IIA, AIC, AEI, or CPCU
• Experience preparing claim reports and participating in client or carrier claim reviews

Licensing & Certifications

• Active workers’ compensation adjuster license as required by the applicable jurisdiction

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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