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: Ontario, CA -must live in CA
Hire Type: Contingent
Pay Range: $50
Work Model: Remote or Hybrid as required by project
Work Shift: Monday-Friday 8 am – 4:30 pm
Recruiter Contact: Sean Craft I sean@marykraft.com I 443-345-3305
Nature & Scope:
Positional Overview
We are seeking an experienced Claims Examiner to handle complex and technically challenging workers’ compensation claims. The role involves analyzing, investigating, and managing high-exposure cases that may include litigation, rehabilitation, and settlement negotiations. The Claims Examiner ensures all claims are adjudicated efficiently and in compliance with service expectations, statutory requirements, and industry best practices.
Role & Responsibility:
Tasks That Will Lead to Your Success
- Analyze and process complex or technically difficult workers’ compensation claims to determine exposure and appropriate benefits.
- Develop and execute detailed action plans to drive timely and cost-effective claim resolutions.
- Negotiate settlements within designated authority levels.
- Assign and maintain appropriate reserves throughout the life of each claim.
- Approve and process payments, adjustments, and settlements in a timely manner.
- Prepare and submit all necessary state filings in accordance with statutory deadlines.
- Manage the litigation process to ensure efficient resolution and cost control.
- Coordinate vendor referrals for investigations, independent medical evaluations, and litigation management.
- Utilize cost containment strategies and vendor partnerships to reduce overall claim expenses.
- Manage claim recoveries including subrogation, Second Injury Fund recoveries, and Medicare/Social Security offsets.
- Communicate claim updates and activity to clients, attorneys, and claimants professionally and promptly.
- Maintain accurate documentation and ensure all claim coding is correct.
- Collaborate with supervisors and management on complex or escalated cases.
Skills & Experience
Qualifications That Will Help You Thrive
- High School Diploma or GED required; bachelor’s degree preferred.
- Professional certification in claims or workers’ compensation (e.g., AIC, CPCU) preferred.
- Minimum of five (5) years of workers’ compensation claims management experience, or an equivalent combination of education and experience.
- In-depth understanding of workers’ compensation laws, insurance principles, and claims procedures.
- Knowledge of cost containment practices, medical management, and recovery processes.
- Strong analytical, interpretive, and negotiation skills.
- Excellent written and verbal communication abilities.
- Proficiency in Microsoft Office and claims management systems.
- Strong organizational and time management skills.
- Ability to work independently and collaboratively within a team.
- Commitment to meeting or exceeding client service expectations.
Salary : $50