Title
Claims Examiner – Workers’ Compensation
Location
Brea, California
Schedule
Monday – Friday, standard business hours
Type
Full-time, Ongoing W2 Contract, New Role & Possible Extensions
Pay Rate
$45.50, with overtime pay
Benefits
Medical, Dental, Vision, 401(k), Life Insurance, Disability Coverage, 1 Week of Paid Sick Leave, No PTO but able to take off
Summary
Our client is seeking a Claims Examiner – Workers’ Compensation to manage complex and high-exposure claims, including those involving litigation and rehabilitation. This role is responsible for analyzing claims, determining benefits, and ensuring timely and accurate adjudication in alignment with industry standards and client-specific requirements.
This position is ideal for a claims professional with strong experience in workers’ compensation, claim investigation, and settlement negotiation who can manage claims independently while maintaining compliance and cost effectiveness.
The Claims Examiner will work closely with claimants, clients, legal teams, and vendors to drive timely resolution and maintain high-quality claim file documentation.
Key Responsibilities
Claims Investigation & Management
- Analyze and process complex or technically difficult workers’ compensation claims
- Investigate claims to determine exposure and establish appropriate action plans
- Manage claims through resolution in a timely and compliant manner
Settlement & Financial Management
- Negotiate settlements within designated authority level
- Calculate and assign claim reserves; manage reserve adequacy throughout the claim lifecycle
- Calculate and issue benefit payments, adjustments, and settlements
Litigation & Compliance
- Manage the litigation process and coordinate with legal teams
- Prepare and submit required state filings within statutory deadlines
- Ensure claim handling aligns with industry best practices and client requirements
Vendor & Cost Management
- Coordinate vendor referrals for investigation and litigation support
- Utilize cost containment strategies and vendor partnerships to control claim expenses
Recovery & Reporting
- Manage claim recoveries including subrogation, Second Injury Fund, and offsets (Social Security/Medicare)
- Report claims to excess carriers and respond to requests in a timely and professional manner
Communication & Documentation
- Communicate claim updates with claimants and clients
- Maintain strong client relationships through professional communication
- Ensure claim files are accurately documented and coded
Required Education & Experience
- Bachelor’s degree from an accredited college or university preferred
- Experience handling workers’ compensation claims, including complex or litigated cases
Required Skills & Qualifications
- Strong knowledge of workers’ compensation claims handling
- Experience investigating and analyzing claim exposure
- Experience negotiating settlements within authority limits
- Ability to calculate reserves and manage financial aspects of claims
- Understanding of litigation management and compliance requirements
- Strong documentation and organizational skills
- Ability to manage multiple claims in a fast-paced environment
- Strong written and verbal communication skills
Preferred Skills & Qualifications
- Professional certification related to workers’ compensation or claims (preferred)
- Experience with high-exposure or litigated claims
- Familiarity with subrogation and recovery processes
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