Workers' Comp Claims Examiners

Location: San Diego
Posted on: June 23, 2025

Job Description:

Two Workers' Comp Claims Examiners Needed in California: Two Locations Our client, a large insurance company, has a need for two Workers' Comp Claims Examiners in one of two locations. One position is located in Roseville, CA (1 st Pref) or Long Beach, CA (2 nd Pref) ( five days/week in the office ) One position is located in San Diego, CA (1 st Pref); San Diego, in Rosedale (2nd Pref) and 3rd Pref would be Concord, CA. (Onsite or hybrid) This is a direct-hire position. You will analyze complex or technically difficult workers' compensation claims to determine benefits due; work with high exposure claims involving litigation and rehabilitation; ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and identify subrogation of claims and negotiate settlements. Essential Functions & Responsibilities Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim Manage claims through well-developed action plans to an appropriate and timely resolution. Negotiate settlement of claims within designated authority. Calculate and assign timely and appropriate reserves to claims Manage reserve adequacy throughout the life of the claim. Calculate and pay benefits due Approve and make timely claim payments and adjustments Settle clams within designated authority level. Prepare necessary state fillings within statutory limits Manage the litigation process and ensure timely and cost effective claims resolution. Coordinate vendor referrals for additional investigation and/or litigation management. Manage claim recoveries, including: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. Qualifications: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. 7-10 years of claims management experience or equivalent combination of education and experience required. 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. SIP (Self-Insurance Program) experience is preferred If you or anyone you know is interested, qualified and available send your resume to us for immediate consideration.

Keywords: , Bellflower , Workers' Comp Claims Examiners, Customer Service & Call Center , San Diego, California