Workers' Compensation Claims Examiner

Jobgether; New York (NY); Remote; USD 62,000 - 76,000; Full time

Job summary

Jobgether, listing on behalf of a partner, seeks a California Workers' Compensation Claims Examiner for fully remote work in the United States. The role focuses on indemnity and litigated California claims, requiring strong investigative skills and knowledge of CA regulations.

Expect to manage a full caseload from reporting to resolution in a fast-paced environment. This temporary-to-permanent opportunity values experience, autonomy, and collaboration with workers, employers, attorneys,

Qualifications

• At least five years of California Workers' Compensation Claims Examiner experience.
• Strong understanding of California workers' compensation laws and procedures.
• Experience handling indemnity and litigated California WC claims from inception to resolution.
• Must reside in California.
• Ability to evaluate medical records, wage data and legal materials.
• Experience negotiating settlements with defense counsel.
• Excellent written and verbal communication skills.
• Strong organizational skills and ability to manage a full caseload while working remotely.
• Experience using claims management systems and MS Office.

Responsibilities

• Manage a full caseload of California workers' compensation claims from initial notification through investigation, administration, negotiation, and final resolution.
• Investigate claims, assess evidence, determine compensability, and establish reserves based on exposure.
• Develop and implement effective claim handling strategies for timely resolutions.
• Coordinate with injured workers, employers, attorneys, medical providers, and other stakeholders.
• Review medical records and wage information to assess exposure and benefits.
• Negotiate settlements and collaborate with defense counsel on litigated claims.
• Maintain accurate claim records in the management system.
• Ensure compliance with California workers' compensation statutes and guidelines.

Skills

California WC experience

Investigation & analytics

Negotiation

Communication

Organization & time mgmt

Independent remote work

Claims systems & MS Office

Education

SIP certification (preferred)

Tools

Claims management systems

Microsoft Office

Job description

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Workers' Compensation Claims Examiner based in the United States.

The Workers' Compensation Claims Examiner will manage California workers' compensation claims from initial reporting through final resolution, ensuring accurate, timely, and compliant claim handling. This role focuses on indemnity and litigated claims, requiring strong investigative skills, sound judgment, and in-depth knowledge of California workers' compensation regulations. You will assess compensability, establish reserves, evaluate claim exposure, and develop appropriate resolution strategies. Working closely with injured workers, employers, attorneys, medical providers, and other professionals, you will coordinate all aspects of the claims process. This fully remote, temporary-to-permanent opportunity is suited to an experienced claims professional who can independently manage a full caseload in a fast-paced, collaborative environment.

Accountabilities

• Claims Management: Manage a full caseload of California workers' compensation claims from initial notification through investigation, administration, negotiation, and final resolution.
• Investigation and Compensability: Investigate claims, assess available evidence, determine compensability, and establish appropriate reserves based on claim circumstances and potential exposure.
• Claim Strategy and Resolution: Develop and implement effective claim handling strategies, monitor case progress, and identify appropriate approaches to achieve timely and fair resolutions.
• Stakeholder Coordination: Maintain regular communication and coordinate with injured workers, employers, attorneys, medical providers, vocational professionals, and other relevant parties throughout the life of each claim.
• Medical and Financial Evaluation: Review medical records, wage information, and supporting documentation to assess claim exposure, determine eligibility, and evaluate appropriate benefits.
• Settlement Negotiation and Litigation: Negotiate settlements and collaborate with defense counsel on litigated claims, supporting effective case management and resolution.
• Documentation and Systems Management: Maintain complete, accurate, and timely claim records within the claims management system, ensuring all relevant activities and decisions are properly documented.
• Regulatory Compliance: Ensure all claim handling activities comply with California workers' compensation statutes, regulations, benefit requirements, and applicable internal guidelines.

Requirements

• Professional Experience: At least five years of experience as a California Workers' Compensation Claims Examiner is required.
• California Regulatory Knowledge: Strong understanding of California workers' compensation laws, regulations, claims procedures, and benefit administration.
• Claims Expertise: Demonstrated experience managing indemnity claims and litigated California workers' compensation cases from inception through resolution.
• Residency: Must currently reside in California.
• Investigation and Analytical Skills: Ability to evaluate medical records, wage documentation, legal materials, and other evidence to determine compensability and assess claim exposure.
• Negotiation Skills: Experience negotiating settlements and working effectively with defense counsel and other stakeholders on complex or litigated claims.
• Communication and Relationship Management: Excellent written and verbal communication skills, with the ability to interact professionally with injured workers, employers, attorneys, medical providers, and other parties.
• Organization and Time Management: Strong organizational skills and the ability to prioritize competing deadlines while maintaining accurate documentation and managing a full caseload.
• Independent Working Style: Ability to work autonomously, exercise sound judgment, and maintain productivity in a fully remote environment.
• Technical Proficiency: Experience using claims management systems and proficiency with Microsoft Office applications.
• Certification: SIP certification is preferred but not required.

Benefits

• Compensation: $45-$55 per hour, depending on experience.
• Work Arrangement: Fully remote position.
• Healthcare Coverage: Medical, dental, and vision benefits available while on assignment.
• Retirement: 401(k) benefits available while on assignment.
• Employment Opportunity: Temporary-to-permanent arrangement, with a strong opportunity for permanent employment based on performance.