Workers Compensation Claims Examiner

Workers’ Compensation Claims Examiner

About the Opportunity
We are partnering with a well-established third-party administrator (TPA) that delivers comprehensive workers’ compensation and risk management services to a broad client base. This organization is recognized for its service-driven approach, operational consistency, and long-standing client partnerships. The environment supports experienced claims professionals who thrive in a fast-paced, accountable setting.

Role Overview
Seeking a seasoned Claims Examiner to take full ownership of a workers’ compensation caseload from initial reporting through final resolution. This position requires a high level of autonomy, technical proficiency, and the ability to manage complex indemnity claims while adhering to regulatory and internal standards.

This role involves consistent interaction with external partners and internal teams, requiring strong communication skills, organization, and attention to detail.

Core Responsibilities

• Oversee a portfolio of approximately 150–180 workers’ compensation claims, including litigated and complex indemnity files

• Perform detailed claim investigations to assess liability and determine compensability

• Administer benefits in compliance with applicable state laws and internal protocols

• Monitor ongoing medical treatment and approve services in alignment with claim strategy

• Partner with defense counsel on litigated matters, providing direction and oversight

• Maintain regular communication with claimants, clients, medical providers, and vendors regarding claim progress

• Set, evaluate, and adjust reserves in accordance with authority levels and claim developments

• Negotiate settlements and bring claims to resolution within approved authority

• Ensure all claim activity is thoroughly documented and maintained within internal systems

• Provide updates and reporting to clients, including trends and risk considerations

• Conduct file reviews to ensure accuracy, quality, and compliance

Qualifications

Experience & Education

• Bachelor’s degree preferred (or equivalent relevant experience)

• Minimum of 5 years handling workers’ compensation claims

• Active California SIP (Self-Insurance Plans) certification required

Technical Skills & Competencies

• In-depth understanding of workers’ compensation regulations and claim lifecycle

• Working knowledge of medical terminology and treatment processes

• Strong analytical thinking and decision-making ability

• Excellent written and verbal communication skills

• Ability to independently manage a high-volume caseload

• Proficiency with Microsoft Office tools (Word, Excel)

• Strong collaboration skills across internal and external stakeholders

Work Setting

• Primarily office-based with extended computer use

• Frequent communication via phone and email

• Standard office physical requirements

What Makes This Role Unique
This position is designed for an experienced examiner who is comfortable handling complex claims and making independent decisions. It offers the opportunity to:

• Take full ownership of challenging files

• Operate with a high level of autonomy

• Manage volume while maintaining quality and accuracy

Ideal for someone looking to step into a role where their expertise is fully utilized and valued.

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