Workers’ Compensation Claims Examiner (Senior-Level)

We are seeking an experienced Workers’ Compensation Claims Examiner to manage complex indemnity claims from inception through resolution. This role offers the opportunity to handle high-impact cases while working in a collaborative, fast-paced environment.

What You’ll Do

• Manage a caseload of approximately 150–180 workers’ compensation claims, including highly complex files
• Conduct timely investigations and determine compensability in accordance with state regulations
• Administer benefits and oversee medical treatment, including billing review and authorization
• Establish and adjust reserves within authority levels
• Partner with defense counsel on litigated claims and direct case strategy as needed
• Communicate regularly with claimants, providers, clients, and internal stakeholders to ensure efficient claim resolution
• Maintain detailed documentation, diary systems, and claim status updates
• Identify trends and provide insights to clients related to risk and safety concerns
• Independently review files and drive claims to timely closure
  
  

What You Bring

• Certified in handling California Self Insured Plans
• 5 years of workers’ compensation claims handling experience, including complex indemnity claims
• Strong knowledge of state regulations, claims processes, and medical terminology
• Proven ability to manage a high-volume caseload independently
• Excellent communication skills with the ability to explain technical information clearly
• Strong analytical and decision-making skills
• Proficiency with Microsoft Office (Word, Excel)
• Relevant state licenses or certifications (as required)
  
  

Why This Role

This is an opportunity to step into a high-impact role where your expertise directly influences claim outcomes, client satisfaction, and organizational success. You’ll work with a supportive team while maintaining autonomy over your caseload.