Senior Workers' Compensation Examiner

King's Insurance Staffing; Sacramento (CA); On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Job summary

King's Insurance Staffing is seeking a Senior Workers’ Compensation Claims Examiner in California to manage indemnity and litigated claims, from initial reporting through resolution. The ideal candidate will independently investigate, evaluate compensability, establish reserves, and coordinate with attorneys and medical providers to move cases toward timely resolution.

Candidates must reside in Sacramento or surrounding area and have a minimum of 3 years’ California WC experience, plus CA

Qualifications

• Minimum of 3 years of workers’ compensation claims adjusting or examining experience.
• Prior experience handling California workers’ compensation claims is required.
• Demonstrated experience managing indemnity and lost-time claims.
• Experience handling litigated workers’ compensation matters.
• Ability to independently manage claims from investigation through final resolution.
• Knowledge of California disability benefits, medical management, reserving, litigation, and settlement practices.
• Experience with self-insured employers or programs is strongly preferred.
• CA Self-Insurance Administrator’s Certificate required, or ability to obtain within timeframe.
• Strong organizational, analytical, written, and verbal communication skills.

Responsibilities

• Manage a caseload of California workers’ compensation claims, including indemnity, lost-time, and litigated files.
• Investigate new claims and evaluate information to determine compensability.
• Oversee claims from initial assignment through settlement or closure.
• Coordinate and monitor medical treatment, disability status, and return-to-work.
• Calculate and issue appropriate benefits, including temporary and permanent disability.
• Evaluate claim exposure and establish, review, and adjust reserves.
• Review medical records, legal correspondence, and investigative findings.
• Work with defense counsel, medical providers, employers, and other parties.
• Develop and execute strategies to move claims toward timely resolution.
• Maintain accurate claim documentation and ensure regulatory compliance.

Skills

Independent decision making

Analytical skills

Written and verbal communication

Education

California Self-Insurance Administrator’s Certificate

Job description

Our client is looking to add an experienced Senior Workers’ Compensation Claims Examiner to their California claims team. This position will manage a caseload of workers’ compensation claims with an emphasis on indemnity and litigated files.

The Claims Examiner will be responsible for overseeing claims from initial reporting through resolution, including investigating losses, evaluating compensability, monitoring medical treatment and disability, establishing reserves, issuing benefits, and coordinating with attorneys and other involved parties. The ideal candidate will have strong knowledge of California workers’ compensation regulations and be comfortable making independent claim decisions.

Candidates must reside in Sacramento, CA or the surrounding area.

Responsibilities

• Manage a caseload of California workers’ compensation claims, including indemnity, lost-time, and litigated files.
• Investigate new claims and evaluate available information to determine compensability.
• Manage claims throughout the full lifecycle, from initial assignment through settlement or closure.
• Coordinate and monitor medical treatment, disability status, and return-to-work activity.
• Calculate and issue appropriate workers’ compensation benefits, including temporary and permanent disability payments.
• Evaluate claim exposure and establish, review, and adjust reserves when appropriate.
• Review medical records, legal correspondence, investigative findings, and other claim documentation.
• Work with defense counsel, medical providers, employers, and other parties involved in the claim.
• Develop and execute strategies to move claims toward timely and appropriate resolution.
• Maintain accurate claim documentation and ensure compliance with California workers’ compensation regulations and internal claims procedures.

Qualifications

• Minimum of 3 years of workers’ compensation claims adjusting or examining experience.
• Prior experience handling California workers’ compensation claims is required.
• Demonstrated experience managing indemnity and lost-time claims.
• Experience handling litigated workers’ compensation matters.
• Ability to independently manage claims from investigation through final resolution.
• Knowledge of California disability benefits, medical management, reserving, litigation, and settlement practices.
• Previous experience handling claims for a self-insured employer or self-insured program is strongly preferred.
• California Self-Insurance Administrator’s Certificate required, or ability to obtain the certification within the required timeframe.
• Strong organizational, analytical, written, and verbal communication skills.
• $90,000–$110,000, depending on experience
• Medical, dental, and vision insurance options