Workers Compensation Claims Examiner

Insurance Placement Solutions (IPS) has an immediate opening for a Workers’ Compensation Claims Examiner with our client in Fresno, California. This is a full-time, temporary opportunity with the potential for temp-to-hire, offering hybrid or remote flexibility. Candidates must have strong California workers’ compensation indemnity claims experience and a current Self-Insurance Administrator (SIP) Certificate.

In this role, you’ll independently manage a caseload of workers’ compensation indemnity claims, including complex files, from investigation through resolution. You’ll determine compensability, administer benefits, coordinate medical treatment, establish reserves, manage litigation, and negotiate settlements while ensuring compliance with California workers’ compensation requirements.

Workers’ Compensation Claims Examiner Responsibilities

• Manage a caseload of approximately 150–180 workers’ compensation claims, including complex indemnity files
• Investigate claims and determine compensability in accordance with California workers’ compensation requirements
• Calculate and administer workers’ compensation benefits within designated authority
• Coordinate medical treatment and review associated medical billing
• Establish and maintain appropriate claim reserves
• Develop and maintain claim strategies and action plans through resolution
• Refer litigated claims to defense counsel and monitor litigation activities
• Evaluate claim exposure and negotiate settlements within designated authority
• Maintain accurate claim documentation and an effective diary system
• Communicate claim developments with claimants, employers, medical providers, attorneys, and clients
• Identify and communicate injury trends or safety concerns to clients
• Participate in claim file reviews as needed
• Ensure claims are handled in accordance with California workers’ compensation regulations and client requirements

Qualifications

• Experience independently managing California workers’ compensation indemnity claims
• Experience handling complex workers’ compensation claims
• Strong knowledge of California workers’ compensation laws, regulations, and claims-handling requirements
• Experience managing claim reserves, litigation, and settlements

Preferred

• Bachelor’s degree in a related field
• Proficiency with Microsoft Word and Excel

Licensing & Certifications

• Current California Self-Insurance Administrator (SIP) Certificate required
• Additional adjuster licensing as required by applicable state regulations

Work Arrangement

• Full-time, temporary opportunity with potential for temp-to-hire
• Hybrid (Fresno, CA) or remote work available

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.

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