Job Description📣
We're Hiring: Senior Claims Examiner - Workers Compensation (California) We're looking for a
Senior Claims Examiner - Workers Compensation (California) with a passion for claims management to join our team!
📘 SIP certification is required
🏅 Proven experience handling California Workers Compensation claims
💼 Strong background in managing advanced, large-loss, and complex cases
Role Overview: 🔍 Investigate and settle advanced, large-loss, and complex claims promptly and equitably with minimal supervision.
📄 Work within established authority on moderate-to-difficult claims, reviewing coverages, determining liability/compensability, collecting statements and essential information, and settling claims using best practices.
⚖ Evaluate and set reserves using independent judgment, support litigation preparation with supervisors and defense attorneys, and contribute to team development through training and mentorship.
Responsibilities- Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.
- Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel.
- Analyzes claims activity and prepares reports for clients/carriers and management.
- Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.
- Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits.
- Develops subrogation and third party recovery potential and follows reclaim procedures.
- Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.
Qualifications- Bachelor's degree or equivalent experience required.
- Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization.
- Ability to work independently while assimilating various technical subjects..
- Strong written and oral communication, negotiation and presentation skills.
- Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects.
- Effective advanced interpersonal skills to effectively interact with all levels of internal and external clients.
- Industry Designations: Preferred: IIA, AIC, AEI, and/or CPCU.
- License Requirements:Per State or Jurisdictional requirements.
- Workers Compensation (WC) Adjuster License required according to jurisdictional requirements
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