Claim Examiner Workers' Compensation (WC)

Important Note Candidates must be currently residing in the state of California to be considered for this role.

Job Description

We are seeking a detail-oriented and experienced Claim Examiner Workers' Compensation (WC) to join our team. The ideal candidate will be responsible for managing and adjudicating workers' compensation claims with moderate complexity, ensuring accurate and timely resolution.

Key Responsibilities

• Receive claim assignments, confirm policy coverage, and initiate claim acknowledgments.
• Interpret policy provisions and make independent decisions on coverage applicability for submitted claims.
• Investigate, evaluate, negotiate, and adjudicate first- and third-party claims.
• Conduct investigations via telephone with clients, claimants, witnesses, and other involved parties as necessary.
• Analyze claim activity and prepare detailed reports for clients, carriers, and management.
• Establish and manage claim reserves using sound judgment and expertise.
• Authorize and issue payments within designated authority limits, ensuring cost-effective claim resolution.
• Make prompt and fair settlement decisions and process claim payments accordingly.
• Identify subrogation opportunities and pursue third-party recovery when applicable.
• Participate in claim reviews and provide insights to stakeholders.

Required Skills

• Ability to work independently while handling multiple technical subject areas.
• Strong verbal and written communication skills.
• Proven ability to gather and analyze information, determine appropriate actions, and execute effectively.
• Excellent problem-solving and analytical skills.
• Strong interpersonal skills with the ability to interact effectively with external stakeholders and all levels of employees.

Education & Experience

• Bachelor s degree or equivalent work experience required.
• 1 3 years of experience in claims handling or a similar environment.
• Experience in workers' compensation claims investigation and settlement preferred.

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