Claims Adjuster - Workers Compensation(Remote)

Nesco Resource; Sacramento (CA); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a skilled Workers' Compensation Claims Examiner to manage complex indemnity claims in California. This remote position requires expertise in California regulations and strong analytical abilities. You will play a critical role in ensuring accurate claims adjudication while maintaining client relationships and compliance with state laws. Ideal candidates will have a minimum of 3 years of experience and a Bachelor's degree. Join a dynamic team and contribute to a comprehensive benefits package that supports your well-being and growth.

Benefits

Medical Coverage

Vision Coverage

Dental Coverage

401K

Employee Assistance Program

Qualifications

• Minimum 3 years of experience handling California Workers' Compensation indemnity claims.
• Bachelor's degree preferred; SIP designation is a plus.

Responsibilities

• Determine compensability and benefits due for long-term indemnity claims.
• Monitor reserve accuracy and submit required documentation to state agencies.
• Develop and manage action plans through claim resolution.

Skills

California WC regulations

Analytical Skills

Communication Skills

Negotiation Skills

Organizational Skills

Microsoft Office Proficiency

Education

Bachelor's degree

Job description

Workers' Compensation Claims Examiner – California (Remote)
Location: Remote (California-based only)

Position Summary:
We are seeking an experienced Workers' Compensation Claims Examiner to manage mid- to high-level indemnity claims for California. This role ensures the accurate adjudication of claims in alignment with state regulations, client expectations, and industry best practices.

Key Responsibilities:

• Determine compensability and benefits due for long-term indemnity claims.

• Monitor reserve accuracy and submit required documentation to state agencies.

• Develop and manage action plans through claim resolution, including return-to-work coordination.

• Process and approve claim payments in accordance with policies and client contracts.

• Identify and manage subrogation opportunities; negotiate settlements.

• Maintain accurate claim documentation and coding; communicate updates with claimants and clients.

• Handle complex lifetime and/or defined period medical claims, including utilization review decisions and regulatory filings.

• Support quality programs and maintain strong client relationships.

• Travel as required.

Qualifications:

• Minimum 3 years of experience handling California Workers' Compensation indemnity claims.

• Bachelor's degree preferred.

• Prior public entity experience is preferred, not required.

• SIP designation is a plus.

Skills & Knowledge:

• Strong knowledge of California WC regulations, disability duration, and medical management practices.

• Proficiency in Microsoft Office; strong analytical, communication, negotiation, and organizational skills.

• Ability to work independently and collaboratively to meet service expectations.

Additional Requirements:

• Must be located in California.

• Credit security clearance (background credit check) required.

Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services.

Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.