Workers' Compensation Claims Examiner III - Salinas, CA (Contract - FULL REMOTE))

Johnson Service Group, Inc.; Salinas (CA); Hybrid; USD 110,000 - 120,000; Part time

Job summary

Johnson Service Group, Inc. seeks a Workers’ Compensation Claims Examiner III for remote/hybrid work from Salinas, CA. You will manage the most complex claims, lead investigations, and direct litigation with senior guidance and client coordination.

Requirements include 7+ years WC experience with indemnity focus, licenses, and strong PD rating and subrogation knowledge. This is a contract role offering advanced responsibilities and flexible work arrangements.

Qualifications

• Minimum 7 years WC claims experience with independent indemnity management.
• CA SIP certificate and active adjuster license required; multi-state preferred.
• Experience directing complex litigation through mediation and trial prep.

Responsibilities

• Lead investigations on complex, high-exposure claims with strategic resolution plans.
• Direct litigation efforts, select counsel, manage expenses, and prepare for trial.
• Oversee PD ratings, reserving, subrogation, and multi-lien resolution.
• Mentor junior staff and provide senior technical guidance to the unit.

Skills

Complex claims handling

Litigation management

Fraud indicators detection

Indemnity reserve setting

Team mentoring

Technical leadership

Education

Bachelor's degree

Tools

Claims management platforms

Job description

Workers' Compensation Claims Examiner III - Salinas, CA (Contract - REMOTE)Pay Rate: 55.55Location: Salinas, CA - REMOTERole Summary:As a Workers’ Compensation Claims Adjuster III you are a senior technical expert trusted with our clients most complex, high-exposure, and strategically sensitive claims—including catastrophic injuries, multi-party litigation, and cases with novel legal or medical challenges. You provide technical guidance and supervisory backup to your unit and serve as a senior resource for clients, carriers, and colleagues.Location & Work Arrangement:Remote or hybrid depending on candidate location.Essential Duties & Responsibilities:Complex Claims Investigation & CompensabilityPerform three-point contact on all new losses and apply heightened scrutiny to complex, catastrophic, and high-exposure cases; maintain detailed plans of action with strategic resolution planning on all assigned indemnity files.Identify fraud indicators and refer to SIU with advanced pattern recognition; gather and document case facts on files involving multi-party liability, catastrophic injury, significant subrogation potential, or novel legal issues.Medical Management, RTW & Vocational RehabilitationLead medical management on catastrophic and high-complexity claims including directing specialists, coordinating life care planners, directing UR and IMEs, and managing PTD cases.Partner with case managers to maximize early RTW; review medical bills for appropriateness on high-cost and unusual treatment patterns.Permanent Disability, Reserving & Financial StewardshipLead PD rating on complex cases including significant apportionment, overlapping injuries, and disputed ratings; establish and adjust reserves on high-exposure files with precision and clear documented justification.Ensure status reports are submitted in compliance with the reporting timelines and formats outlined in individual client instructions.Litigation ManagementIndependently direct the full litigation process on the unit’s most complex files including selecting defense counsel, setting strategy, retaining experts, managing legal spend, and preparing for trial.Lead mediations, settlement conferences, and arbitrations; make or recommend high-value settlement authority decisions in coordination with the Claims Supervisor and client.Settlements, Lien Resolution & RecoveryIndependently negotiate and finalize high-value settlements including C&R and Stipulated Awards; manage multi-lien resolution (MSA, Medi-Cal, provider, attorney liens) and coordinate with lien counsel and CMS as required.Aggressively pursue subrogation, multi-defendant contribution, and apportionment recovery; coordinate with recovery vendors and outside subrogation counsel on high-value opportunities.Technical Leadership & Supervisory BackupServe as technical backup for the Claims Supervisor; provide guidance on complex decisions, reserve adequacy, and escalated client issues; mentor Adjuster I and II colleagues and support unit-wide quality review.Serve as a senior point of contact for key client accounts on complex or escalated matters; maintain client and carrier relationships with professionalism and technical authority.Professionalism & CommunicationMaintain proactive, transparent communication with all stakeholders; respond within required timeframes and project a professional, expert image in all interactions.Qualifications:Education & ExperienceMinimum 7 years of WC claims experience including at least 5 years of independent indemnity management with expertise in complex, high-exposure, and litigated files; ORBachelor’s degree and a minimum of 5 years of WC indemnity experience at an independent level; OR equivalent combination.Comprehensive knowledge of public entity liability claims including JPAs, self-insured programs, and pooled insurance arrangements.Licenses & CertificationsActive adjuster license in applicable state(s) required; multi-state preferred.CA SIP certificate required for CA files. (CA only)Professional designations such as AIC, ARM, WCCP, or CPCU a plus but not required.Technical & Subject Matter ExpertiseDeep expertise in applicable state WC statutes; California statute mastery strongly preferred. Multi-jurisdiction experience highly valued.Direct experience working within one or more claims administration or claims processing platforms commonly used in worker’s compensation/insurance claims handling.Demonstrated experience directing complex litigation through mediation, settlement conference, and trial preparation; advanced knowledge of PD rating, MSA requirements, and multi-party lien resolution.Experience with catastrophic injury management and life care planning coordination; familiarity with claims management platforms; proficiency in Microsoft Office.Leadership & Interpersonal SkillsDemonstrated ability to mentor junior adjusters and serve as a supervisory backup or senior technical resource.Strong client relationship management skills; experience handling escalated concerns at a senior level.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.**JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.**#D720