What are the responsibilities and job description for the Workers Compensation Claims Examiner position at Imagine Staffing Technology?
Job Profile
Job Title: Claims Examiner
Location: San Diego CA
Hire Type: Contingent
Pay Range: $50 per/Hr.
Work Model: Remote
Work Shift: Monday-Friday
Recruiter Contact: Sean Craft I sean@marykraft.com I 443-345-3305
Nature & Scope:
Positional Overview
We are currently seeking an experienced Workers Compensation Claims Examiner to join our team. This role is responsible for managing complex and high-exposure California workers' compensation claims. The ideal candidate will demonstrate strong knowledge of California WC laws, experience in litigation management, and an ability to drive claims toward timely and effective resolutions. California SIP certification is preferred but not required.
Role & Responsibility:
Tasks That Will Lead to Your Success
- Investigate, analyze, and process complex or high-exposure workers' compensation claims in accordance with applicable laws and company policies.
- Develop and manage strategic action plans to ensure efficient claims resolution.
- Negotiate claim settlements within authorized limits.
- Establish and maintain accurate reserves; monitor and adjust as appropriate throughout the life of each claim.
- Approve and process timely benefit payments and necessary adjustments.
- Submit state filings in compliance with statutory deadlines.
- Oversee litigation process, working closely with legal teams to ensure cost-effective claim closure.
- Coordinate external vendors for medical or investigative services as needed.
- Apply cost containment techniques including partnerships with preferred vendors.
- Manage recoveries, including subrogation efforts and Second Injury Fund reimbursement.
- Report to excess insurance carriers and respond promptly to directives.
- Maintain clear communication with claimants, clients, and internal stakeholders.
- Ensure documentation is accurate, complete, and meets audit standards.
- Refer high-risk or complex cases to supervisors as needed.
Skills & Experience
Qualifications That Will Help You Thrive
- High School Diploma or GED required.
- California SIP certification preferred but not required.
- Minimum of 3 years handling California workers' compensation claims required.
- 5 years of total claims management experience preferred.
- In-depth knowledge of CA workers' compensation laws and procedures.
- Proficient in reserve management, claim valuation, and benefit calculation.
- Exceptional communication skills – verbal, written, and interpersonal.
- Strong negotiation and decision-making abilities.
- Organized and detail-oriented with excellent documentation habits.
- Comfortable using Microsoft Office and claims management software.
- Ability to thrive in a fast-paced, team-oriented environment.
- Strong sense of urgency and responsiveness to management and client needs.
Salary : $50
