Senior WC Claims Examiner - Litigated & Complex

Ultimate Staffing; Fresno (CA); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Life and Disability Insurance

401(k)

Job summary

Ultimate Staffing is seeking a skilled Claims Examiner III to manage complex and litigated workers' compensation indemnity claims from assignment through resolution in California. You will collaborate with claimants, attorneys, medical providers, and internal teams, set reserves, authorize medical treatment, and pursue recoveries while ensuring compliance with state laws and company standards.

Candidates should have at least 5 years of workers' compensation experience, California licensure where

Qualifications

• Minimum 5 years of workers' compensation claims experience.
• California workers' compensation experience preferred.
• Licensing/certifications as required by the jurisdiction.

Responsibilities

• Manage a caseload of complex and litigated workers' compensation claims.
• Investigate claims and determine compensability.
• Administer benefits according to applicable state laws.
• Authorize and manage medical treatment and medical billing.
• Coordinate with defense counsel on litigated claims.
• Set and maintain claim reserves.
• Negotiate settlements and obtain appropriate authority approvals.
• Maintain detailed claim documentation and diary management.
• Communicate with clients regarding claim status, trends, and safety concerns.
• Identify subrogation opportunities and pursue recoveries.
• Handle excess reporting and reimbursement matters.
• Assist with state audits and regulatory reporting.

Skills

Workers' comp laws

Medical terminology

Analytical skills

Written communication

Microsoft Word / Excel

Tools

SIP experience

Job description

Ultimate Staffing is seeking a skilled Claims Examiner III to manage complex and litigated workers' compensation indemnity claims from assignment through resolution in California. You will collaborate with claimants, attorneys, medical providers, and internal teams, set reserves, authorize medical treatment, and pursue recoveries while ensuring compliance with state laws and company standards.

Candidates should have at least 5 years of workers' compensation experience, California licensure where