Worker Compensation Claims Examiner III (Hybrid)

Ultimate Staffing Services; Fresno (CA); On-site; USD 48,000 - 61,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k)

Paid Holidays

Paid Time Off

Employee Referral Bonus

Job summary

Ultimate Staffing Services is seeking a Claims Examiner III to manage complex and litigated workers' compensation indemnity claims in California. You will work with claimants, attorneys, medical providers, and internal teams to ensure compliance and timely resolutions.

The role requires at least 5 years of workers' compensation experience, a solid understanding of regulations, and strong analytical and communication skills.

Qualifications

• Strong understanding of workers' compensation laws and regulations.
• Knowledge of medical terminology.
• Excellent analytical, written, and verbal communication skills.
• Ability to work effectively with attorneys, claimants, clients, and medical professionals.
• Proficiency with Microsoft Word and Excel preferred.

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 authority approvals.
• Maintain detailed claim documentation and diary management.
• Communicate with clients regarding claim status and trends.
• 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 communication skills

Interpersonal with attorneys/clients

MS Word & Excel

Tools

Microsoft Word

Excel

Job description

Salary: USD35 - USD44 per hour

Schedule: Full-Time, 8am to 5pm

Position Overview

This role is responsible for managing complex and litigated workers' compensation indemnity claims from assignment through resolution. The Claims Examiner III works closely with claimants, attorneys, medical providers, nurse case managers, vocational experts, vendors, clients, and internal staff to ensure claims are handled in compliance with state regulations and company best practices.

Key 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.

Required Qualifications

Experience

• Minimum of 5 years of workers' compensation claims experience.
• Proven ability to manage highly complex and litigated claims independently.

SIP experience require

Knowledge & Skills

• Strong understanding of workers' compensation laws and regulations.
• Knowledge of medical terminology.
• Excellent analytical, written, and verbal communication skills.
• Ability to work effectively with attorneys, claimants, clients, and medical professionals.
• Proficiency with Microsoft Word and Excel preferred.

Licensing

• Appropriate workers' compensation claims licenses/certifications as required by the jurisdiction.

Ideal Candidate Profile

• Significant California workers' compensation claims experience.
• Experience handling litigated indemnity claims.
• Reserve-setting and settlement authority experience.
• Experience mentoring or training other claims professionals.
• Knowledge of subrogation, apportionment, state audits, and excess reporting.

Benefits

• Medical, Dental, and Vision Insurance
• Life and Disability Insurance
• 401(k)
• Paid Holidays
• Paid Time Off
• Employee Referral Bonus