Claims Examiner

REQ Solutions; California (MO); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading company is seeking a Workers’ Compensation Claims Examiner to manage complex indemnity claims. The ideal candidate will have strong experience in California Workers’ Compensation and an OSIP certificate. This remote position requires excellent analytical and negotiation skills, with a focus on compliance and client satisfaction. Join a dynamic team and contribute to effective claims management.

Qualifications

• Minimum 3 years of California Workers’ Compensation claims handling experience required.
• OSIP Certificate is mandatory.
• Indemnity claims experience is a must.

Responsibilities

• Analyze and manage complex California Workers’ Compensation claims.
• Develop and maintain proactive claims action plans.
• Negotiate settlements within designated authority limits.

Skills

Analytical Skills

Negotiation Skills

Communication Skills

Interpersonal Skills

Education

High school diploma or GED

Bachelor's degree

Tools

Microsoft Office

Claims Management Software

Job description

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This range is provided by REQ Solutions. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$40.00/hr - $50.00/hr

Job Title: Claims Examiner

Pay Range: $50 per/Hr.

Work Model: Remote

Work Shift: Monday-Friday

Nature & Scope:

We are seeking a highly skilled Workers’ Compensation Claims Examiner to handle complex and high-exposure indemnity claims for a public entity client. The successful candidate will have strong California Workers’ Compensation claims handling experience and an active OSIP (Office of Self-Insurance Plans) certificate.

This position will be responsible for investigating, analyzing, and resolving technically challenging workers’ compensation claims while ensuring compliance with state regulations, service expectations, and client requirements.

Role & Responsibility:

Tasks That Will Lead to Your Success

• Analyze and manage complex or high-exposure California Workers’ Compensation claims.
• Develop, implement, and maintain proactive claims action plans to ensure timely and appropriate resolution.
• Determine compensability and benefit entitlement, issue payments accordingly.
• Calculate and assign reserves accurately; monitor for adequacy throughout the claim lifecycle.
• Negotiate settlements within designated authority limits.
• File state-required forms and documentation within statutory deadlines.
• Manage litigation processes, working closely with attorneys and vendors to ensure cost-effective resolution.
• Coordinate return-to-work initiatives and medical case management when applicable.
• Pursue claim recoveries including subrogation, Second Injury Fund, and Medicare/SS offsets.
• Maintain ongoing communication with claimants, clients, and internal team members.
• Ensure claim files are accurately coded and thoroughly documented.
• Report applicable claims to excess carriers and respond to direction requests.
• Refer complex matters to supervisors or management when appropriate.

Skills & Experience

Qualifications That Will Help You Thrive

• High school diploma or GED required; bachelor’s degree preferred.
• OSIP Certificate is mandatory.
• Additional industry certifications are a plus.
• Minimum 3 years of California Workers’ Compensation claims handling experience required.
• Indemnity claims experience is a must.
• Public entity claims experience preferred.
• Deep understanding of California WC laws, disability duration, and cost containment practices.
• Knowledge of medical management and Social Security/Medicare offset procedures.
• Strong analytical, negotiation, and communication skills.
• Proficient in Microsoft Office and claims management software.
• Organized and capable of managing multiple priorities in a fast-paced environment.
• Excellent interpersonal skills with a client-focused approach.
• Any key words you’d like used for searching:
• High school diploma or GED required
• OSIP Certificate is mandatory.
• Additional industry certifications are a plus.
• Minimum 3 years of California Workers’ Compensation claims handling experience required.
• Indemnity claims experience is a must.
• Public entity claims experience preferred.
• Deep understanding of California WC laws, disability duration, and cost containment practices.
• Knowledge of medical management and Social Security/Medicare offset procedures.
• Strong analytical, negotiation, and communication skills.
• Proficient in Microsoft Office and claims management software.
• Organized and capable of managing multiple priorities in a fast-paced environment.
• Excellent interpersonal skills with a client-focused approach.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Accounting/Auditing and Finance

• Industries

  Insurance and Insurance and Employee Benefit Funds

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