Workers’ Compensation Claims Examiner (Senior-Level)
TEEMA Solutions Group, Pleasanton, CA, United States
We are seeking an experienced Workers’ Compensation Claims Examiner to manage complex indemnity claims from inception through resolution. This role offers the opportunity to handle high-impact cases while working in a collaborative, fast-paced environment.
What You’ll Do
Manage a caseload of approximately 150–180 workers’ compensation claims, including highly complex files
Conduct timely investigations and determine compensability in accordance with state regulations
Administer benefits and oversee medical treatment, including billing review and authorization
Establish and adjust reserves within authority levels
Partner with defense counsel on litigated claims and direct case strategy as needed
Communicate regularly with claimants, providers, clients, and internal stakeholders to ensure efficient claim resolution
Maintain detailed documentation, diary systems, and claim status updates
Identify trends and provide insights to clients related to risk and safety concerns
Independently review files and drive claims to timely closure
What You Bring
Certified in handling California Self Insured Plans
5+ years of workers’ compensation claims handling experience, including complex indemnity claims
Strong knowledge of state regulations, claims processes, and medical terminology
Proven ability to manage a high-volume caseload independently
Excellent communication skills with the ability to explain technical information clearly
Strong analytical and decision‑making skills
Proficiency with Microsoft Office (Word, Excel)
Relevant state licenses or certifications (as required)
Why This Role
This is an opportunity to step into a high-impact role where your expertise directly influences claim outcomes, client satisfaction, and organizational success. You’ll work with a supportive team while maintaining autonomy over your caseload.
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What You’ll Do
Manage a caseload of approximately 150–180 workers’ compensation claims, including highly complex files
Conduct timely investigations and determine compensability in accordance with state regulations
Administer benefits and oversee medical treatment, including billing review and authorization
Establish and adjust reserves within authority levels
Partner with defense counsel on litigated claims and direct case strategy as needed
Communicate regularly with claimants, providers, clients, and internal stakeholders to ensure efficient claim resolution
Maintain detailed documentation, diary systems, and claim status updates
Identify trends and provide insights to clients related to risk and safety concerns
Independently review files and drive claims to timely closure
What You Bring
Certified in handling California Self Insured Plans
5+ years of workers’ compensation claims handling experience, including complex indemnity claims
Strong knowledge of state regulations, claims processes, and medical terminology
Proven ability to manage a high-volume caseload independently
Excellent communication skills with the ability to explain technical information clearly
Strong analytical and decision‑making skills
Proficiency with Microsoft Office (Word, Excel)
Relevant state licenses or certifications (as required)
Why This Role
This is an opportunity to step into a high-impact role where your expertise directly influences claim outcomes, client satisfaction, and organizational success. You’ll work with a supportive team while maintaining autonomy over your caseload.
#J-18808-Ljbffr