Workers' Comp Claims Examiners
Location: San Diego
Posted on: June 23, 2025
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Job Description:
Two Workers' Comp Claims Examiners Needed in California: Two
Locations Our client, a large insurance company, has a need for two
Workers' Comp Claims Examiners in one of two locations. One
position is located in Roseville, CA (1 st Pref) or Long Beach, CA
(2 nd Pref) ( five days/week in the office ) One position is
located in San Diego, CA (1 st Pref); San Diego, in Rosedale (2nd
Pref) and 3rd Pref would be Concord, CA. (Onsite or hybrid) This is
a direct-hire position. You will analyze complex or technically
difficult workers' compensation claims to determine benefits due;
work with high exposure claims involving litigation and
rehabilitation; ensure ongoing adjudication of claims within
service expectations, industry best practices, and specific client
service requirements; and identify subrogation of claims and
negotiate settlements. Essential Functions & Responsibilities
Analyze and process complex or technically difficult workers'
compensation claims by investigating and gathering information to
determine the exposure on the claim Manage claims through
well-developed action plans to an appropriate and timely
resolution. Negotiate settlement of claims within designated
authority. Calculate and assign timely and appropriate reserves to
claims Manage reserve adequacy throughout the life of the claim.
Calculate and pay benefits due Approve and make timely claim
payments and adjustments Settle clams within designated authority
level. Prepare necessary state fillings within statutory limits
Manage the litigation process and ensure timely and cost effective
claims resolution. Coordinate vendor referrals for additional
investigation and/or litigation management. Manage claim
recoveries, including: subrogation, Second Injury Fund excess
recoveries and Social Security and Medicare offsets. Communicates
claim activity and processing with the claimant and the client;
maintains professional client relationships. Qualifications:
Bachelor's degree from an accredited college or university
preferred. Professional certification as applicable to line of
business preferred. 7-10 years of claims management experience or
equivalent combination of education and experience required.
Subject matter expert of: Appropriate insurance principles and laws
for line-of-business handled Recoveries offsets and deductions
Claim and disability duration Cost containment principles including
medical management practices and Social Security and Medicare
application procedures as applicable to line-of-business. SIP
(Self-Insurance Program) experience is preferred If you or anyone
you know is interested, qualified and available send your resume to
us for immediate consideration.
Keywords: , Fountain Valley , Workers' Comp Claims Examiners, Customer Service & Call Center , San Diego, California
