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Claims Examiner- Worker's Compensation (remote in CA only)

Remote, USA Full-time Posted 2025-05-22

Claim Examiner - Workers’ Compensation (remote)

Location: Must reside in the state of California...

Pay: Depends on experience

Duties of the Claim Examiner - Workers’ Compensation:
• Receive claim assignments and confirm policy coverages.
• Interpret and make decisions using independent judgment on moderate difficulty claims and policy coverages.
• Investigate, evaluate, negotiate, and adjudicate first and third-party claims to determine validity and verify the extent of damage. This involves telephone contact with clients, claimants, witnesses, or other relevant parties.
• Analyze claims activity and prepare reports for clients, carriers, and management.
• Establish reserves, authorize payments within the scope of authority, and settle claims in a cost-effective manner, ensuring timely disbursements.
• Make prompt and equitable settlement decisions, issuing company drafts for authorized claims.
• Develop subrogation and third-party recovery potential, following reclaim procedures.
• Participate in claim reviews.

Job Requirements

Skills Required for the Claim Examiner - Workers’ Compensation:
• Ability to work independently while assimilating various technical subjects.
• Strong verbal and written communication skills.
• Demonstrated ability to gather and analyze information, determine a course of action, and implement the selected approach.
• Proficiency in problem-solving and identifying solutions.
• Effective interpersonal skills for dealing with external sources and colleagues at all levels.

Education:
• Bachelor’s degree or equivalent experience required.
• 1-3 years of comprehensive claims investigations/settling experience in Workers’ Compensation or a similar organization

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