Senior Claims Examiner, Workers' Compensation

Keenan & Associates; Riverside (CA); Hybrid; USD 75,000 - 105,000; Full time

Job summary

A leading insurance brokerage and consulting firm is seeking a California Workers' Compensation Claims Examiner. The role involves administering indemnity claims, maintaining diaries, and ensuring client satisfaction. Competitive salary and comprehensive benefits, including paid time off and health plans, are offered. Remote work flexibility is available, but candidates must have relevant California experience.

Benefits

Generous 30+ days paid time off

Health benefit options

Company match 401(k) plan

Fitness and wellness discounts

Access to licensed therapists

Pet benefits and discounts

Qualifications

• Minimum 5 years of California Workers' Compensation Claims Examiner experience.
• Ability to pass Self-Insurance Test within 1 year of hire.
• 2 years experience in handling public entity claims preferred.

Responsibilities

• Administer indemnity claims and handle complex claim issues.
• Maintain current diary and update claim notes.
• Prepare for and attend file reviews.

Skills

Effective verbal and written communication

Customer service skills

Litigation management experience

Lien resolution abilities

Education

Self-Insurance Certificate

WCCP preferred

Tools

Microsoft Outlook

Microsoft Excel

Microsoft PowerPoint

Microsoft Word

Job description

Overview

Administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation.

Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities, and California school districts. Keenan specializes in providing consulting services in the areas of employee benefits, workers' compensation, loss control, financial, and property & liability.

What You'll Do

1. Maintain current diary.
2. Identify, prevent, and mitigate potential penalties.
3. Update claim notes in the computer system.
4. Provide timely reporting of excess files to the Reinsurance Manager.
5. Report SIU/Fraud.
6. Identify and pursue subrogation.
7. Complete Rehab forms/benefit notices/SJDB/RTW forms.
8. Refer all PRIME deletions only to the office designee.
9. Update reserves within 30 days of receipt of information modifying the financial exposure of a claim.
10. Prepare for and attend file reviews.
11. Accept or deny delayed claims within 90 days.
12. Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date.
13. Complete Stipulation and/or Compromise and Release paperwork.
14. Maintain a 100% closing ratio on active accounts and reduce runoff accounts by 25% annually.
15. Prepare legal referrals, provide direction to, and monitor defense attorneys.
16. Return all phone calls within 24 hours.
17. Complete instruction sheets for assistants, technicians, and claims entry clerks.
18. Review mail daily.
19. Correct error reports daily.
20. Maintain client/claimant satisfaction.
21. Update Unit Stat forms.
22. Oversee new set-ups, reserves, and instruction sheets.
23. Prepare cover letters to AME/defense QME, AOE/COE evaluations.
24. Negotiate outstanding liens.
25. Make 3-point contact.
26. File Answer/Application.
27. Interact with nurses on case management.
28. Perform other duties as assigned.

What You'll Need

• Minimum of five (5) years of California Workers' Compensation Claims Examiner experience and a Self-Insurance Certificate, or the ability to pass the Self-Insurance Test within one (1) year of hire. WCCP preferred.
• Two (2) years of experience in handling public entity claims is preferred.
• Effective in verbal and written communication.
• Proficient in Microsoft Outlook, Excel, PowerPoint, and Word. Adept at accessing business data from the Internet when required.

What's in it For You?

To help you make the best decision for your personal growth, it’s important to us to share a glimpse of what we offer our top asset, our people:

• Competitive base salary.
• Generous 30+ days comprehensive paid time off package, including paid time off, 10 company holidays, 2 floating holidays, 5 sick days, and 2 volunteer days.
• Health benefit options with affordable medical plans, company-paid HSA contributions, dental plans with orthodontia coverage, and vision plans.
• Company match 401(k) plan – 50% up to 6%!
• Support for your fitness and wellness goals, with discounts at gyms and fitness centers.
• Access to licensed therapists for mental health support.
• Pet benefits and discounts.
• Access to Employee-led Resource Groups (ERGs).

Compensation:

The target salary range for this position is $75,000 to $105,000 annually. The actual salary will vary based on education, experience, skills, abilities, internal equity, and geographic location. Remote work flexibility is available, but candidates must have California workers' compensation claims experience.

Grow with us

Accretive is a collection of elite agencies supported by experienced industry leaders. We value relationships and deliver customized solutions and service you can trust.

We are passionate about fueling our clients’ innovation and growth, making us an ideal place for creative, dynamic individuals to grow their careers while helping businesses, families, and individuals thrive. We are committed to diversity, equity, and inclusion, embracing the unique perspectives and contributions of all team members, and fostering a workplace that thrives on diversity.