California Workers' Compensation Claims Representative | Remote
King's Insurance Staffing, California, Missouri, United States, 65018
Our client is looking for an experienced Senior Workers’ Compensation Claims Examiner to manage a portfolio of complex California workers’ compensation claims from inception through final resolution. This role requires deep technical expertise, sound judgment, and the ability to independently handle high-exposure and litigated matters while delivering strong claim outcomes and exceptional service.
The ideal candidate is confident navigating California-specific regulations, skilled in negotiation strategy, and comfortable collaborating with legal counsel and medical professionals to drive efficient and compliant claim resolution.
Responsibilities
Independently manage a caseload of complex indemnity and litigated California Workers’ Compensation claims.
Conduct detailed investigations to determine compensability, exposure, and appropriate claim strategy.
Establish and maintain accurate financial reserves based on claim developments, medical exposure, and legal considerations.
Direct litigation strategy in partnership with defense counsel, including evaluation of AME/QME reports and deposition testimony.
Evaluate permanent disability exposure and calculate benefits in accordance with California rating guidelines.
Negotiate settlements, including Compromise & Release and Stipulated Award agreements, within granted authority levels.
Ensure timely administration of indemnity benefits and medical payments in compliance with statutory requirements.
Maintain proactive diary management and move files efficiently toward resolution.
Identify subrogation opportunities and coordinate recovery efforts when applicable.
Provide clear and timely communication to injured workers, employers, brokers, and internal stakeholders. Analyze claim trends, identify risk drivers, and recommend strategies to mitigate overall loss exposure.
Participate in roundtables and peer file reviews to ensure technical accuracy and best practices.
Requirements
Minimum 5+ years handling California Workers’ Compensation claims, including complex indemnity and litigated files.
Strong background managing high-severity and high-exposure claims.
Experience working for an insurance carrier or third-party administrator (TPA).
Proven ability to set and manage reserves effectively.
Demonstrated expertise in California Labor Code, DWC procedures, disability rating, and settlement practices.
Skilled negotiator with strong litigation management capabilities.
Proficient in claims management software and documentation systems.
Strong analytical thinking and sound decision-making skills.
Salary & Benefits
$42.00 – $55.00 per hour (depending on experience)
Remote work flexibility within California
Comprehensive health benefits package (Medical, Dental, Vision, Life) while on assignment
Temporary-to-Hire opportunity within 1-3 months
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The ideal candidate is confident navigating California-specific regulations, skilled in negotiation strategy, and comfortable collaborating with legal counsel and medical professionals to drive efficient and compliant claim resolution.
Responsibilities
Independently manage a caseload of complex indemnity and litigated California Workers’ Compensation claims.
Conduct detailed investigations to determine compensability, exposure, and appropriate claim strategy.
Establish and maintain accurate financial reserves based on claim developments, medical exposure, and legal considerations.
Direct litigation strategy in partnership with defense counsel, including evaluation of AME/QME reports and deposition testimony.
Evaluate permanent disability exposure and calculate benefits in accordance with California rating guidelines.
Negotiate settlements, including Compromise & Release and Stipulated Award agreements, within granted authority levels.
Ensure timely administration of indemnity benefits and medical payments in compliance with statutory requirements.
Maintain proactive diary management and move files efficiently toward resolution.
Identify subrogation opportunities and coordinate recovery efforts when applicable.
Provide clear and timely communication to injured workers, employers, brokers, and internal stakeholders. Analyze claim trends, identify risk drivers, and recommend strategies to mitigate overall loss exposure.
Participate in roundtables and peer file reviews to ensure technical accuracy and best practices.
Requirements
Minimum 5+ years handling California Workers’ Compensation claims, including complex indemnity and litigated files.
Strong background managing high-severity and high-exposure claims.
Experience working for an insurance carrier or third-party administrator (TPA).
Proven ability to set and manage reserves effectively.
Demonstrated expertise in California Labor Code, DWC procedures, disability rating, and settlement practices.
Skilled negotiator with strong litigation management capabilities.
Proficient in claims management software and documentation systems.
Strong analytical thinking and sound decision-making skills.
Salary & Benefits
$42.00 – $55.00 per hour (depending on experience)
Remote work flexibility within California
Comprehensive health benefits package (Medical, Dental, Vision, Life) while on assignment
Temporary-to-Hire opportunity within 1-3 months
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