Workers Compensation, Risk Analyst 3

Jobtailor; Fullerton (CA); On-site; USD 65,000 - 90,000; Full time

Job summary

Jobtailor in California seeks an experienced claims professional to manage moderately complex workers’ compensation claims, including high exposure and litigated matters. You will determine benefits, subrogation opportunities, and settlements while investigating claims with injured workers, providers, and employers.

The role requires strong knowledge of workers’ compensation laws, excellent communication, and the ability to manage multi-state claims with precision.

Qualifications

• High school diploma or GED with two years of workers’ compensation claims handling experience
• Strong understanding of workers’ compensation laws and regulations, claim principles, and application
• Strong verbal and written communication and negotiation skills
• Ability to work collaboratively in a team environment; must always use good judgment
• Excellent time management and organizational skills
• Ability to manage claims across multiple state jurisdictions
• IEA Certificate and/or California Self Insured Certificate preferred

Responsibilities

• Manage moderately complex workers’ compensation claims, including high exposure and litigated claims
• Determine benefits due and ensure claims are managed within internal guidelines and applicable laws
• Identify opportunities for and manage claim subrogation and negotiate settlements
• Thoroughly investigate claims by contacting injured workers, medical providers, employer representatives, and witnesses
• Determine claim validity under applicable workers’ compensation statutes
• Communicate with medical providers to develop and authorize treatment plans
• Manage time loss claims and support early return to work
• Review and analyze medical bills for relatedness and treatment-line plan compliance
• Ensure timely payment of medical bills and income replacement
• Calculate and assign reserves and manage reserve adequacy
• Manage recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets
• Prepare required state filings within statutory limits
• Oversee and work with outside counsel on litigation and settlement negotiations
• Collaborate in the office with the claims team and supervisor on complex and litigated claims
• Report directly to the Risk Claims Supervisor

Skills

Workers’ Compensation Claims Tracking

Claim Investigation

Negotiation

Communication Skills

Attention to Detail

Education

Bachelor’s degree (preferred)

IEA Certificate (preferred)

California Self Insured Certificate (preferred)

Tools

Standard Office Equipment

Computer Proficiency

Job description

• Manage moderately complex workers’ compensation claims, including high exposure and litigated claims
• Determine benefits due and ensure claims are managed within internal guidelines and applicable laws
• Identify opportunities for and manage claim subrogation and negotiate settlements
• Thoroughly investigate claims by contacting injured workers, medical providers, employer representatives, and witnesses
• Determine claim validity under applicable workers’ compensation statutes
• Communicate with medical providers to develop and authorize treatment plans
• Manage time loss claims and support early return to work
• Review and analyze medical bills for relatedness and treatment-line plan compliance
• Ensure timely payment of medical bills and income replacement
• Calculate and assign reserves and manage reserve adequacy
• Manage recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets
• Prepare required state filings within statutory limits
• Oversee and work with outside counsel on litigation and settlement negotiations
• Collaborate in the office with the claims team and supervisor on complex and litigated claims
• Report directly to the Risk Claims Supervisor

Requirements

• High school diploma or general education degree (GED) and two years of workers’ compensation claims handling experience required
• Strong understanding of workers’ compensation laws and regulations, claim principles, and application
• Strong verbal and written communication and negotiation skills
• Ability to work positively and collaboratively in a team environment; must always use good judgment
• Excellent time management and organizational skills
• High level of attention to details while working in a fast-paced environment
• Frequent use of computers, telephones, and other standard office equipment
• Ability to maintain ongoing education credits in a multitude of states
• Ability to manage claims across multiple state jurisdictions
• IEA Certificate preferred
• California Self Insured Certificate preferred
• Bachelor's degree from four-year college or university preferred

Core Competencies

Demonstrates expertise in managing workers' compensation claims, including high exposure and litigated cases, while ensuring compliance with applicable laws and regulations. Proficient in negotiation, communication, and collaboration within a team environment to achieve optimal claim outcomes.

Highest-signal resume keywords

• Workers’ Compensation Claims Management
• Claim Investigation and Validity Assessment
• Negotiation and Settlement Skills
• Strong Communication Skills
• Attention to Detail

Hard Skills

• Claims Handling
• Subrogation Management
• Medical Bill Review
• Reserve Calculation
• Statutory Filing Preparation

Soft Skills

• Team Collaboration
• Time Management
• Organizational Skills
• Good Judgment

Certifications & Qualifications

• IEA Certificate
• California Self Insured Certificate

Industry Keywords

• Workers’ Compensation Laws
• Claim Principles
• Multi-State Jurisdiction Management

Tools & Technologies

• Standard Office Equipment
• Computer Proficiency