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 residing in California, with preference given to candidates within driving distance of Roseville or Long Beach for occasional onsite client meetings and training.

In this role, you’ll manage California indemnity and litigated workers’ compensation claims, including complex and high-exposure files. You’ll oversee claims from investigation through resolution, including compensability, benefits, reserves, litigation, settlements, medical management, and recovery opportunities.

Workers’ Compensation Claims Examiner Responsibilities

• Analyze and process complex California workers’ compensation claims
• Investigate claims and gather information to determine compensability and exposure
• Manage indemnity 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 the litigation process 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
• Refer complex or escalated matters to management as appropriate

Qualifications

• Minimum of 5 years of California workers’ compensation claims experience
• Experience handling indemnity and litigated California workers’ compensation claims
• Experience managing complex or high-exposure claims

Preferred

• Bachelor’s degree from an accredited college or university
• Professional insurance or claims designation

Licensing & Certifications

• California Self-Insured Plans (SIP) certificate required

Work Arrangement

• Candidates must reside in California
• Preference for candidates within driving distance of Roseville or Long Beach, California
• Ability to attend occasional onsite client meetings and training, including quarterly meetings, as needed

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.