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 residing in California.

In this role, you’ll manage complex California workers’ compensation claims, including high-exposure and litigated files. You’ll investigate and evaluate claims, administer benefits, establish reserves, manage litigation, negotiate settlements, and identify recovery opportunities while moving claims toward timely and cost-effective resolution.

Workers’ Compensation Claims Examiner Responsibilities

• Analyze and process complex California workers’ compensation claims
• Investigate claims and gather information to determine compensability and exposure
• Develop and maintain action plans to move claims toward 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 and respond to requests for information
• 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 3 years of recent California workers’ compensation claims experience
• Experience handling complex or high-exposure workers’ compensation claims
• Experience managing workers’ compensation claims involving litigation

Preferred

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

Technical Skills

• Proficiency with Microsoft Office applications
• Experience working with claims management systems

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.