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.