Workers Comp Claims Examiner
Job Description
- Pay range: $40.00 to $50.00 per hour.
- Job type: Contract/Temporary.
Job Summary
We are seeking an experienced Workers Comp Claims Examiner for a contract opportunity supporting California workers' compensation claims. This role is ideal for a claims professional who understands California WC regulations, can manage complex and litigated files, and is comfortable working independently in a remote environment while residing within California.
The Workers Comp Claims Examiner will handle technically complex claims, evaluate benefits, coordinate with stakeholders, and help ensure claims are administered accurately, timely, and in alignment with service expectations and industry best practices. This opportunity offers remote flexibility (must be in California), exposure to complex claims work, and the chance to contribute to a professional claims environment that values accuracy, collaboration, accountability, and strong claim outcomes.
Key Responsibilities include:
- Analyze complex or technically difficult California workers' compensation claims to determine compensability, benefits due, reserves, and appropriate claim strategy.
- Manage high-exposure claims involving litigation, rehabilitation, medical management, and settlement negotiations.
- Ensure ongoing adjudication of claims in accordance with California workers' compensation regulations, industry best practices, service standards, and client requirements.
- Identify potential subrogation opportunities and coordinate appropriate recovery actions.
- Communicate with injured workers, attorneys, employers, medical providers, and internal stakeholders to move claims toward timely resolution.
- Negotiate settlements and document claim activity clearly, accurately, and in compliance with established procedures.
Hours:
- Work arrangement: 7.5 hrs a day
- Remote, but candidates must be located within California.
- Office Location: Roseville, CA.
Requirements:
- Minimum 3 years of relevant California workers' compensation claims experience is mandatory.
- Five years of claims management experience, or an equivalent combination of education and experience, is required.
- California workers' compensation claims handling experience is required.
- Active OSIP certificate is required.
- Strong knowledge of California workers' compensation laws, claims processes, litigation management, and benefit administration.
Equal Opportunity Employer / Disabled / Protected Veterans
The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf
The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.
AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf
We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
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