Manage a caseload of California workers’ compensation claims from initial assignment through final resolution
Review and evaluate coverage, liability, and compensability in accordance with California Labor Code and regulatory requirements
Conduct thorough investigations, including gathering statements, reviewing reports, and analyzing claim documentation
Set and manage reserves based on exposure and claim developments
Ensure timely and accurate benefit payments and required communications
Maintain claim diaries and ensure consistent follow up throughout the life of the claim
Coordinate return to work efforts and monitor ongoing claim activity
Oversee litigation, including working with defense counsel and participating in claim strategy discussions
Negotiate settlements within authority and provide recommendations on cases exceeding authority
Identify potential fraud, subrogation, and cost containment opportunities
Maintain accurate and compliant documentation within the claims system
Communicate effectively with injured workers, employers, medical providers, attorneys, and internal stakeholders

3+ years of experience handling workers’ compensation claims required
Current California Adjuster Certification required
Experience handling California self-insured workers’ compensation claims required, including qualification through the California Office of Self-Insurance Plans (OSIP) or holding a Certified Workers’ Compensation Professional (CWCP) designation required
Strong knowledge of California workers’ compensation laws and claims handling practices
Experience managing indemnity claims, litigation, and claim resolution strategies
Strong analytical, decision making, and problem solving skills
Excellent verbal and written communication skills
Strong organizational skills and ability to manage multiple claims
Ability to work independently in a remote environment
Proficiency with Microsoft Office and claims management systems

Workers Compensation Claims Examiner

Key skills