Senior California Workers' Comp Claims Examiner

Insurance Journal; California, Northern (MO, KY); Hybrid; USD 57,000 - 95,000; Full time

Job summary

Insurance Journal is seeking an intermediate-level workers' compensation claims handler with California experience to manage moderate to difficult claims, determine compensability through thorough investigation, and negotiate settlements within authority. The role includes reserving, managing medical bills, and facilitating return to work, within state law requirements.

The candidate will handle complex files, stay current on California workers' compensation statutes, and collaborate with

Qualifications

• Bachelor's degree in a related field or equivalent experience.
• Three years in workers' compensation claims environment with handling complex claims.
• Bilingual skills preferred.

Responsibilities

• Verifies workers' compensation coverage for employers and injured employees.
• Determines compensability through investigation of the claim.
• Assesses causal relationship to ensure appropriate benefit payments.
• Facilitates return to work for injured employees.
• Establishes reserves based on claim profile within authority.
• Documents claim details with potential subrogation.
• Manages medical bills for indemnity and non-indemnity claims.
• Closes files to meet performance standards and comply with laws.
• Negotiates settlements within authority at earliest appropriate point.
• Mentors team members and supports agents/clients.

Skills

Computer skills

Medical terminology

Workers' compensation laws

Communication skills

Negotiation

Decision making

Education

Bachelor's degree in a related field

Job description

Insurance Journal is seeking an intermediate-level workers' compensation claims handler with California experience to manage moderate to difficult claims, determine compensability through thorough investigation, and negotiate settlements within authority. The role includes reserving, managing medical bills, and facilitating return to work, within state law requirements.

The candidate will handle complex files, stay current on California workers' compensation statutes, and collaborate with