Workers Compensation Claims Examiner

Insurance Placement Solutions (IPS) has an immediate opening for a Workers’ Compensation Claims Examiner III with our client. This is a hybrid direct-hire opportunity based in the Sacramento/Rancho Cordova, California area, with two days per week in the office.

In this role, you’ll independently manage complex and litigated California workers’ compensation indemnity claims from inception through resolution. You’ll investigate claims, determine compensability, manage medical treatment and litigation, establish reserves, negotiate settlements, pursue recoveries, and work closely with clients, claimants, attorneys, medical providers, and other claims professionals.

Workers’ Compensation Claims Examiner III Responsibilities

• Manage a caseload of complex and litigated California indemnity claims
• Conduct timely and thorough claim investigations
• Determine compensability and administer benefits in accordance with California workers’ compensation requirements
• Manage medical treatment and medical billing
• Refer appropriate cases to defense counsel and actively participate in litigation management
• Establish and maintain appropriate claim reserves
• Evaluate, negotiate, and finalize claim settlements within designated authority
• Maintain an effective diary system and detailed plans of action
• Communicate with claimants, attorneys, medical providers, vendors, and clients regarding claim developments
• Conduct scheduled claim file reviews with clients and management
• Identify and evaluate claims for apportionment
• Identify subrogation opportunities and pursue appropriate recoveries
• Identify claims meeting excess reporting criteria and assist with reimbursement
• Assist with state audits and required reporting
• Mentor less experienced Claims Examiners
• Handle additional workers’ compensation jurisdictions as assigned

Qualifications

• Minimum of 5 years of workers’ compensation claims handling experience
• Strong California lost time/indemnity claims experience
• Experience independently managing complex and litigated workers’ compensation claims
• Knowledge of California workers’ compensation statutory requirements and medical terminology
• Experience managing claims from investigation through settlement and resolution

Preferred

• Experience with apportionment, subrogation, and excess reporting
• Experience mentoring less experienced claims professionals
• Proficiency with Microsoft Word and Excel

Licensing

• Current California Self-Insurance Plans (SIP) Certificate required
• Must maintain any additional licensing required for assigned jurisdictions

Work Arrangement

• Direct-hire opportunity
• Hybrid schedule based in Rancho Cordova/Sacramento, California
• Two days per week in the office
• Full-time position

Benefits

• Medical, dental, and vision insurance
• Life and disability insurance
• 401(k) plan
• Paid holidays
• Paid time off
• Referral bonus program

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.