Workers’ Compensation Claims Examiner

Insurance Placement Solutions (IPS) has an immediate opening for a Workers’ Compensation Claims Examiner with our client. This is a fully remote opportunity for candidates located in California.

In this role, you’ll manage complex and high-exposure California workers’ compensation claims involving litigation, medical management, rehabilitation, and recovery opportunities. You’ll investigate and evaluate claims, establish reserves, administer benefits, manage litigation, negotiate settlements, and develop effective action plans to move claims toward timely resolution.

Workers’ Compensation Claims Examiner Responsibilities

• Analyze and process complex or technically difficult California workers’ compensation claims
• Investigate claims and gather information to determine exposure and compensability
• Develop and execute action plans to move claims toward timely resolution
• Manage high-exposure claims involving litigation and rehabilitation
• Establish and maintain appropriate reserves throughout the life of the claim
• Calculate and administer workers’ compensation benefits
• Negotiate settlements within designated authority
• Manage the litigation process and work toward timely, cost-effective claim resolution
• Coordinate vendor referrals for investigations, medical management, and litigation support
• Utilize appropriate cost-containment strategies to manage overall 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 and respond to requests for information
• Communicate claim activity and developments with claimants and clients
• Maintain accurate 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 California workers’ compensation claims handling experience
• Experience handling lost time/indemnity workers’ compensation claims
• Experience managing complex or high-exposure claims
• Experience handling litigated workers’ compensation claims
• Strong knowledge of California workers’ compensation laws and claims handling practices

Preferred

• Bachelor’s degree from an accredited college or university
• Professional insurance or claims designation
• Experience with subrogation, excess recoveries, and Medicare or Social Security offsets

Licensing

• Must obtain and maintain any certifications or licenses required to handle California workers’ compensation claims

Work Arrangement

• Fully remote opportunity
• Candidates must reside in California

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.