Claims Examiner – Workers' Compensation

Jobtailor; San Diego (CA); On-site; USD 75,000 - 110,000; Full time

Job summary

Jobtailor in San Diego, CA seeks an experienced claims specialist to manage a moderately complex claims inventory, coordinating with policyholders, agents, attorneys, and witnesses to gather information and provide exceptional customer service.

The role involves investigating claims, making strategic recommendations, and using mediation, negotiation, denial, litigation, or offers to drive resolutions within regulatory guidelines.

Qualifications

• Bachelor's degree or equivalent required.
• 1–4+ years’ related claims handling experience.
• Workers’ Compensation Certification required.
• State Workers Compensation License required in some branches.
• WCCA and WCCP preferred.
• Knowledge of workers’ compensation laws and jurisdictional rules.
• Strong communication and time-management skills.

Responsibilities

• Manage all aspects of a moderately complex claims inventory.
• Communicate with policyholders, agents, attorneys, and witnesses to gather information and provide customer service
• Investigate claims to determine exposure, work with experts, and make strategic recommendations
• Use mediation, negotiation, denial, litigation, or offers to drive claim resolutions
• Operate within state and governing-entity rules, regulations, and internal claims-handling policies
• Partner with defense counsel throughout litigation while monitoring legal fees and costs
• Collaborate with cross-functional team members on projects and process discussions
• Recommend process improvements and ensure claims-system data accuracy for regulatory reporting
• Provide knowledge transfer across the organization and attend job-related training
• Prepare and present claims status reports for internal and external stakeholders
• Administer, manage, and approve timely benefits payments to injured workers within authority levels
• Create and adjust reserves in accordance with company policies
• Resolve claims fairly and equitably while providing legally required benefits
• No supervisory responsibilities

Skills

Verbal communication

Time management

Attention to detail

Organizational skills

Adaptability

Education

Bachelor's degree

Workers' Compensation Certification

State Workers Compensation License

WCCA

WCCP

Job description

• Manage all aspects of a moderately complex claims inventory
• Communicate with policyholders, agents, attorneys, and witnesses to gather information and provide customer service
• Investigate claims to determine exposure, work with experts, and make strategic recommendations
• Use mediation, negotiation, denial, litigation, or offers to drive claim resolutions
• Operate within state and governing-entity rules, regulations, and internal claims-handling policies
• Partner with defense counsel throughout litigation while monitoring legal fees and costs
• Collaborate with cross-functional team members on projects and process discussions
• Recommend process improvements and ensure claims-system data accuracy for regulatory reporting
• Provide knowledge transfer across the organization and attend job-related training
• Prepare and present claims status reports for internal and external stakeholders
• Administer, manage, and approve timely benefits payments to injured workers within authority levels
• Create and adjust reserves in accordance with company policies
• Resolve claims fairly and equitably while providing legally required benefits
• No supervisory responsibilities

Requirements

• Bachelor's degree (or equivalent combination of education and experience) required
• Minimum 1–4+ years’ related claims or claims handling experience
• Workers’ Compensation certification meeting minimum standards of training, experience, and skill required
• State Workers Compensation License required in some branches
• WCCA and WCCP preferred
• Basic to good understanding of laws and jurisdictional restraints to manage claims
• Excellent verbal communication, time management, attention to detail, and organizational skills
• Adept at learning new technology
• Flexibility to adapt to changes in a fast-paced environment
• Ability to read, analyze, and interpret technical and legal documents
• Ability to write reports and business correspondence
• Ability to respond to common inquiries or complaints from customers, claimants, and regulatory agencies
• Ability to present information at meetings, to management, and clients
• Ability to solve practical problems and deal with variables where limited standardization exists
• Knowledge of workers’ compensation claims handling, reserving, litigation management, and resolution strategies
• Employment sponsorship is not offered for this opportunity

Core Competencies

Demonstrates expertise in managing claims inventory, including investigation, negotiation, and resolution strategies within regulatory frameworks. Proficient in workers' compensation claims handling, with strong communication and organizational skills to effectively collaborate with stakeholders.

Highest-signal resume keywords

• Workers' Compensation Certification
• State Workers Compensation License
• Claims Handling Experience
• Negotiation Skills
• Claims Investigation

ATS Optimization Keywords

Hard Skills

• Claims Management
• Claims Investigation
• Litigation Management
• Reserving
• Regulatory Reporting
• Process Improvement
• Data Accuracy
• Technical Document Analysis
• Report Writing
• Customer Service

Soft Skills

• Verbal Communication
• Time Management
• Attention to Detail
• Organizational Skills
• Adaptability

Certifications & Qualifications

• Workers' Compensation Certification
• WCCA
• WCCP

Industry Keywords

• Claims Inventory
• Mediation
• Negotiation
• Litigation
• Legal Compliance
• Claims Resolution
• Cross-Functional Collaboration
• Benefits Payments
• Jurisdictional Restraints
• Claims Handling Policies