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Claims Examiner
Orange, CA, US
Office
High School or equivalent
Full Time, Temporary
47
Experienced (Non-Manager)
On-site
Legal Services
First Shift (Day)
Orange, CA, US
47
Experienced (Non-Manager)
Full Time, Temporary
Legal Services
On-site
Office
High School or equivalent
First Shift (Day)
Job details
Claims Examiner
About the Role
We’re seeking an experienced Claims Examiner (Workers’ Compensation) to join our client’s team in Orange, CA. The ideal candidate will analyze and manage complex or technically difficult workers’ compensation claims, ensuring timely resolution and adherence to best practices.
You’ll handle high-exposure cases involving litigation, rehabilitation, and settlement negotiations, while maintaining professional client relationships and ensuring compliance with all state regulations.
Location: Orange, CA (Hybrid – 2 days onsite per week)
Pay Rate: $47/hour
Key Responsibilities
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Investigate, analyze, and process complex workers’ compensation claims to determine exposure and benefits due.
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Develop and execute action plans to drive timely and appropriate claim resolution.
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Negotiate settlements within designated authority.
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Calculate and manage reserves throughout the life of the claim.
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Prepare and submit necessary state filings within statutory limits.
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Manage litigation process, vendor coordination, and cost containment efforts.
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Handle recoveries, subrogation, and Second Injury Fund/Medicare offsets.
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Maintain accurate documentation and ensure proper claims coding.
Qualifications
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Experience: Minimum of 3 years of workers’ compensation claims examiner experience (required).
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Education: High School Diploma or GED required; Bachelor’s degree preferred.
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Skills:
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Strong knowledge of insurance principles, workers’ compensation laws, and medical management practices.
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Excellent analytical, negotiation, and communication skills.
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Proficiency with Microsoft Office and claims management systems.
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Strong organizational and multitasking abilities.
Additional Information
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Work Environment: Hybrid (2 days onsite in Orange, CA).
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Security: Credit and background check required.
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Schedule: Monday – Friday, standard business hours.
10010563
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