Workers' Compensation Claims Examiner

2 weeks ago

California, United States ALOIS Solutions Full time
Job Title: Workers' Compensation Claims Examiner

Location: Fully Remote

Job Summary:

ALOIS Solutions is seeking a skilled Workers' Compensation Claims Examiner to join our team. As a key member of our claims management team, you will be responsible for analyzing complex workers' compensation claims, negotiating settlements, and ensuring timely and cost-effective claims resolution.

Key Responsibilities:

  • Analyze and process complex workers' compensation claims, investigating and gathering information to determine exposure and manage claims through well-developed action plans.
  • Negotiate settlements within designated authority and calculate and assign timely and appropriate reserves to claims.
  • Calculate and pay benefits due, approve and make timely claim payments and adjustments, and settle claims within designated authority level.
  • Prepare necessary state filings within statutory limits and manage the litigation process to ensure timely and cost-effective claims resolution.
  • Coordinate vendor referrals for additional investigation and/or litigation management and use cost containment techniques to reduce overall cost of claims for our clients.
  • Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets, and report claims to the excess carrier.
  • Communicate claim activity and processing with the claimant and the client, maintaining professional client relationships and ensuring claim files are properly documented and claims coding is correct.

Requirements:

  • Bachelor's degree from an accredited college or university preferred, with professional certification as applicable to line of business preferred.
  • Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge:

  • Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
  • Excellent oral and written communication, including presentation skills, and PC literate, including Microsoft Office products.
  • Analytical and interpretive skills, strong organizational skills, good interpersonal skills, excellent negotiation skills, and ability to work in a team environment and meet or exceed Service Expectations.

  • Claims Examiner

    2 days ago

    California City, United States Apidel Technologies Full time

    Minimum 3years of relevant CA WC claims experience is mandatoryCalifornia WC Claims handling experiencePrimary Purpose To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service...

  • Senior Claims Examiner

    3 weeks ago

    Brea, California, United States Crawford & Company Full time

    About the RoleCrawford & Company is seeking a highly skilled Senior Claims Examiner to join our team. As a Senior Claims Examiner, you will be responsible for investigating and settling complex claims, working closely with our clients and stakeholders to ensure timely and equitable resolutions.Key ResponsibilitiesInvestigate and settle advanced, large loss,...

  • Claims Adjuster

    2 weeks ago

    California, United States TSR Consulting Services, Inc. Full time

    Job Title: Claims Adjuster - Workers CompensationTSR Consulting Services, Inc. is seeking a skilled Claims Adjuster - Workers Compensation to join our team.Job Summary:We are looking for a highly motivated and detail-oriented Claims Adjuster - Workers Compensation to investigate, analyze, and determine the extent of insurance company's responsibility for...

  • Workers Compensation Claims Adjuster

    3 weeks ago

    Folsom, California, United States Gallagher Full time

    About the RoleWe are seeking a skilled Workers Compensation Claims Adjuster to join our team at Gallagher. As a key member of our Claims Adjuster team, you will play a critical role in investigating, evaluating, and resolving workers compensation claims.Key ResponsibilitiesInvestigate and evaluate workers compensation claims to determine the extent of...

  • Workers Compensation Claims Adjuster

    4 weeks ago

    Folsom, California, United States Gallagher Full time

    About the RoleGallagher is seeking a highly skilled Workers Compensation Claims Adjuster to join our team. As a Claims Adjuster, you will be responsible for investigating, evaluating, and resolving complex workers compensation claims.Key ResponsibilitiesInvestigate and evaluate workers compensation claims to determine liability and extent of...

  • Claims Examiner

    3 weeks ago

    Pleasanton, California, United States AssuredPartners Full time

    Job SummaryWe are seeking a highly skilled Senior Claims Examiner to join our team at AssuredPartners. As a Senior Claims Examiner, you will be responsible for administering indemnity claims and handling complex claim issues. You will use your strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine...

  • Insurance Claims Examiner

    3 days ago

    California, United States TSR Consulting Services, Inc. Full time

    Job Title: Claims AdjusterJob ID: 80354Rate: $45-$48/hr w2Job Summary: As a Claims Adjuster, you will investigate, analyze, and determine the extent of insurance company's responsibility for lost wages, medical benefits, and permanent impairment.Key Responsibilities:Analyze first reports to determine the nature of loss, coverage provided, and scope of...

  • Senior Workers Compensation Claims Adjuster

    1 week ago

    Folsom, California, United States Gallagher Full time

    About the RoleWe are seeking a highly skilled Claims Adjuster to join our team at Gallagher. As a key member of our Claims Adjuster team, you will be responsible for investigating, evaluating, and resolving complex workers compensation claims in California.Key ResponsibilitiesInvestigate and evaluate claims to determine liability and extent of damagesDevelop...

  • Workers Compensation Attorney

    3 weeks ago

    California, United States Stealth Law Firm Full time

    Job SummaryStealth Law Firm is seeking a highly skilled Workers Compensation Associate Attorney to join our team. As a Workers Compensation Associate Attorney, you will be responsible for advocating on behalf of insurance carriers, third party administrators, and self-insured employers in California.Key ResponsibilitiesAdvocate on behalf of insurance...

  • Claims Specialist

    4 months ago

    California, United States CorVel Corporation Full time

    The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote position. ESSENTIAL...

  • WC Claims Specialist

    3 months ago

    California, United States CorVel Corporation Full time

    The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a remote position. ESSENTIAL...

  • Workers Compensation Attorney

    3 days ago

    California, USA, United States Stealth Law Firm Full time

    Job Title: Workers Compensation Associate AttorneyWe are seeking a highly skilled Workers Compensation Associate Attorney to join our team at Stealth Law Firm.Key Responsibilities:Advocate on behalf of insurance carriers, third-party administrators, and self-insured employersPrepare correspondence to clientsDraft pleadingsAttend court appearancesManage...

  • Property Insurance Claims Examiner

    3 weeks ago

    California, United States SERVPRO Global DRT Full time

    About Our OrganizationSERVPRO Global DRT is a leading provider of emergency and reconstruction services. We offer best-in-class solutions to handle complex claims and reconstruction needs 24/7.Job SummaryWe are seeking a highly skilled Property Insurance Claims Examiner to join our Estimating Department. As a key member of our team, you will be responsible...

  • Workers Compensation Defense Attorney

    7 days ago

    California, United States Larson Maddox Full time

    Job Title: Workers Compensation Defense AttorneyLarson Maddox is seeking a talented Workers Compensation Defense Attorney to join their growing Southern California presence in San Diego. As a Workers Compensation Defense Attorney, you will represent the Insurance Firm in various workers' compensation claims, developing effective strategies to minimize...

  • CA Senior Claims Specialist

    4 weeks ago

    California, United States CorVel Corporation Full time

    The Senior Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to...

  • Claims Assistant

    1 month ago

    California, United States CorVel Corporation Full time

    The Claims Assistant will assist and support the claims staff in the set-up and administration of workers' compensation claims/case management and other tasks depending on the specific needs of the customers. This is a hybrid work arrangement. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Sets up new claims Process mail, handle files (until paperless), and...

  • California Claims Assistant

    4 weeks ago

    Irvine, California, United States CCMSI Full time

    About CCMSICCMSI is a leading Third Party Administrator in self-insurance services, dedicated to delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Our employee satisfaction and retention ranks in...

  • Workers Compensation Defense Attorney

    3 weeks ago

    California, United States Career Consulting Partners Full time

    About the RoleCareer Consulting Partners is seeking a highly skilled Workers Compensation Defense Attorney to join our team. As a Workers Compensation Defense Attorney, you will be responsible for handling workers' compensation defense cases throughout Southern California.Key ResponsibilitiesConduct thorough legal research to build effective defense...

  • Workers Compensation Defense Attorney

    4 weeks ago

    California, United States Verrus Full time

    Job Title – Workers Compensation AttorneyPackage - TBD (dependent on experience)Location – CaliforniaThe Company:Verrus is an esteemed law firm that has been providing innovative legal services to employers for over three decades. Founded on the principle of delivering high-quality professional legal services to the employer community of California, our...

  • Workers Compensation Defense Attorney

    6 days ago

    California, United States Career Consulting Partners Full time

    Job Title: Workers Compensation Defense AttorneyCareer Consulting Partners is seeking a skilled Workers Compensation Defense Attorney to join our team. As a Workers Compensation Defense Attorney, you will be responsible for handling workers' compensation defense cases throughout Southern California.Key Responsibilities:Conduct legal research to build...