Workers' Comp Claims Examiners

Company: Managed Care Staffers
Location: La Jolla
Posted on: May 2, 2025

Job Description:

Two Workers' Comp Claims Examiners Needed in California: Two Locations

Apply promptly! A high volume of applicants is expected for the role as detailed below, do not wait to send your CV.

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 (1st Pref) or Long Beach, CA (2nd Pref) (five days/week in the office)

One position is located in San Diego, CA (1st 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.



We understand that you cannot submit any comments or text with your resume. If you apply through Monster, please send a separate email to cjepsen[at]managedcarestaffers.com with the answers to the following questions in order to be considered for this position:


How many years' experience do you have as a Workers Compensation Claims Examiner?
Do you have indemnity and litigation experience?
Do you have a Bachelor's degree?
Please list any professional certifications you have.
Have you managed self-insured program (SIP) Workers' Comp. cases for clients?
Can you work onsite or do you require hybrid?
Can you work (onsite or hybrid) in San Diego, Rosedale or Concord, CA?
Can you work (onsite all 5 days) in Roseville or Long Beach, CA?
What minimum annual salary requirements do you require?
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: Managed Care Staffers, Garden Grove , Workers' Comp Claims Examiners, Other , La Jolla, California