Workers' Compensation Claims Examiner

Jobgether; United States; Remote; USD 62,000 - 76,000; Full time

Benefits offered by this job

Fully remote position

Competitive hourly pay $45–$55

Healthcare coverage (medical, dental,/

401(k) benefits

Temp-to-perm opportunity

Job summary

Jobgether is seeking a Workers' Compensation Claims Examiner based in the United States to manage California WC claims remotely from reporting to final resolution. The role emphasizes indemnity and litigated claims with strong investigative skills, judgment, and regulatory knowledge.

Expect full caseload management in a fast-paced, fully remote environment. Ideal candidates have five+ years of CA WC experience, residency in California, and proficient use of claims systems and MS Office.

Qualifications

• At least five years of experience as a California Workers' Compensation Claims Examiner.
• Strong knowledge of California workers' compensation laws and regulations.
• Experience handling indemnity and litigated CA WC claims from start to finish.
• Must reside in California.
• Ability to evaluate medical/wage documentation and other evidence.
• Experience negotiating settlements with defense counsel and stakeholders.

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.
• Develop and implement claim handling strategies for timely, fair resolutions.
• Coordinate with injured workers, employers, attorneys, medical providers, and other parties.
• Review medical records and wage information to assess exposure and benefits.
• Negotiate settlements and support litigated claims with defense counsel.
• Maintain complete, accurate claim records in the management system.
• Ensure compliance with California workers' compensation statutes and guidelines.

Skills

Investigations

Negotiation

Communication

Time management

Independent work

MS Office

Education

SIP Certification (preferred)

Tools

Claims management system

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.

How Jobgether Works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Data Privacy Notice:

By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.