Claims Examiner

1 month ago

Orange, United States Experis Full time
Title: Claims Examiner - Workers Compensation
Location: Must be located in California (Remote Work in CA)
Duration: 4 months
Pay Range : $45/hr (On W2)

We are looking for a "Claims Examiner - Workers Compensation "to join one of our Fortune 500 clients.

Job Summary:
To analyze complex workers' compensation claims, determine benefits, manage high-exposure and litigated cases, ensure timely adjudication, and identify subrogation opportunities while negotiating settlements

Requirements:
  • 3+ years of California Workers' Compensation experience required
  • Remote work location in California
  • SIP Certification mandatory

Job Responsibilities:
  • Investigate and analyze complex workers' compensation claims
  • Develop action plans for timely claim resolution
  • Negotiate settlements within designated authority
  • Calculate and assign appropriate reserves
  • Process benefit payments and claim adjustments
  • Prepare state filings within statutory limits
  • Ensure proper claim file documentation and coding
  • Report claims to excess carriers and respond to inquiries
  • Manage the litigation process for timely, cost-effective resolution
  • Coordinate vendor referrals for investigations and litigation management
  • Implement cost containment techniques and strategic partnerships
  • Handle claim recoveries, including subrogation and excess recoveries
  • Manage Social Security and Medicare offsets
  • Communicate claim activity with claimants and clients
  • Maintain professional client relationships

Additional Responsibilities
  • Perform other duties as assigned
  • Support organizational quality programs
  • Travel as required

Education and Licensing
  • Bachelor's degree preferred
  • Professional certification in relevant line of business preferred

Experience
  • 5+ years of claims management experience or equivalent

Skills and Knowledge
  • Expert knowledge of insurance principles and laws
  • Proficient in recoveries, offsets, and cost containment practices
  • Excellent communication and presentation skills
  • Proficient in Microsoft Office


We are looking for the candidate who are eligible to work with any employers without sponsorship .

If you're interested, please click "Apply" button.

If you are not available or this job is not a good fit at present, please share the job details with your friends/colleagues and let me know if anyone is interested

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