Claims Examiner Worker Compensation

Job Profile Job Title: Claims ExaminerLocation: Rancho Cucamonga, CA -must live in CAHire Type: Contingent Pay Range: $50Work Model: Remote Work Shift: Monday-Friday 8 am – 4:30 pm Recruiter Contact: Sean Craft I sean@marykraft.com I 443-345-3305 Nature & Scope:Positional OverviewWe are seeking a skilled Claims Examiner with experience handling complex or technically challenging Workers’ Compensation claims. The Claims Examiner will investigate, analyze, and manage high-exposure cases, including litigated and rehabilitation claims, ensuring accurate benefit determination and adherence to industry’s best practices. This role will work remotely but must reside within the state of California.Role & Responsibility:Tasks That Will Lead to Your Success Analyze and process complex workers’ compensation claims, determining claim exposure through detailed investigation.Develop and execute action plans to ensure timely and appropriate claim resolution.Evaluate, calculate, and maintain accurate reserves across the life of each claim.Approve and process benefits, payments, and adjustments in accordance with authority levels.Prepare and submit all required state filings within statutory timeframes.Manage litigation activities and collaborate with legal partners to ensure cost-effective outcomes.Coordinate vendor referrals for investigations, medical reviews, or litigation support.Utilize cost-containment strategies, including partnerships with approved vendors, to minimize overall claim expenses.Manage recovery opportunities such as subrogation, Second Injury Fund recoveries, and Social Security/Medicare offsets.Report applicable claims to excess carriers and respond promptly to direction requests.Maintain ongoing communication with claimants and clients, fostering strong professional relationships.Ensure claim documentation is complete, accurate, and compliant with coding standards.Escalate cases to supervisors or management when necessary.. Skills & ExperienceQualifications That Will Help You Thrive High School Diploma or GED required.Bachelor’s degree preferred.Professional certifications related to workers’ compensation or claims management preferred.Minimum 5 years of claims management experience, or an equivalent combination of experience and education.In-depth understanding of workers’ compensation laws, insurance principles, recovery practices, and cost containment strategies.Strong analytical, investigative, and interpretive abilities.Excellent written and verbal communication skills, including presentation ability.High proficiency with Microsoft Office and claims management systems.Strong negotiation skills and ability to resolve disputes effectively.Organized, detail-oriented, and capable of managing multiple cases simultaneously.Team-oriented with strong interpersonal skills.Ability to meet or exceed service expectations consistently.

Salary : $50