Senior Claims Examiner (Workers’ Compensation)
Location: Folsom, California
Work Arrangement: Onsite
Contract Duration: 3 months, W2
Pay: $32.00/hr
Position Summary
We are seeking an experienced Senior Claims Examiner to manage complex workers’ compensation claims through the full claim lifecycle. This role requires strong analytical, investigative, and decision-making skills to evaluate coverage, manage litigation activities, establish reserves, negotiate settlements, and ensure timely claim resolution. The ideal candidate will thrive in a fast-paced environment and be comfortable handling complex claims independently while collaborating with legal counsel, clients, and other stakeholders.
Key Responsibilities
- Investigate, evaluate, and manage complex workers’ compensation claims from inception through resolution.
- Interpret policy provisions and determine coverage applicability using sound judgment and industry expertise.
- Oversee all aspects of claim investigations, including gathering evidence, reviewing documentation, and evaluating liability and exposure.
- Develop and direct litigation strategies in partnership with legal counsel.
- Establish and maintain appropriate claim reserves and authorize payments within designated authority levels.
- Negotiate and settle claims in a timely, fair, and cost-effective manner.
- Issue claim payments and ensure proper documentation and compliance with applicable regulations and company procedures.
- Identify and pursue subrogation and third-party recovery opportunities.
- Analyze claim activity and prepare reports for clients, carriers, and management.
- Participate in claim reviews and provide recommendations regarding claim strategy and resolution.
- Maintain accurate claim documentation and ensure timely communication with all interested parties.
Required Qualifications
- Bachelor’s degree or equivalent combination of education and relevant experience.
- 4-8 years of claims handling, claims investigation, or claims settlement experience.
- Workers’ Compensation Adjuster License required based on applicable jurisdictional requirements.
- Strong understanding of workers’ compensation claims processes, regulations, and industry best practices.
- Proven ability to independently manage complex claims and make sound coverage and settlement decisions.
- Excellent written and verbal communication skills.
- Strong negotiation and presentation abilities.
- Advanced analytical, problem-solving, and decision-making skills.
- Ability to manage multiple priorities and deadlines in a fast-paced environment.
Preferred Qualifications
- Professional industry designations such as:
- Associate in Claims (AIC)
- Associate in Claims Law (AEI)
- Insurance Institute of America (IIA)
- Chartered Property Casualty Underwriter (CPCU)
- Experience handling highly complex or litigated workers’ compensation claims.
- Demonstrated expertise in reserve management, settlement strategy, and claim cost containment.
Key Competencies
- Claims Investigation & Resolution
- Workers’ Compensation Claims Management
- Litigation Management
- Coverage Analysis
- Reserve Analysis
- Negotiation & Settlement
- Risk Assessment
- Subrogation Recovery
- Client Relationship Management
- Regulatory Compliance
- Written & Verbal Communication
- Problem Solving & Critical Thinking
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