Want to know if you’re a fit? Upload your resume and let our AI show you.
Skills
Analysis Skillsunmatched
Claims Processingunmatched
Disbursementsunmatched
Establish Prioritiesunmatched
Institute of Internal Auditors (IIA)unmatched
Legalunmatched
Litigationunmatched
Multitaskingunmatched
Negotiation Skillsunmatched
Presentation/Verbal Skillsunmatched
Problem Solving Skillsunmatched
Reporting Skillsunmatched
Subrogationunmatched
Time Managementunmatched
Work From Homeunmatched
Worker's Compensationunmatched
Writing Skillsunmatched
Description
Department:
06040 | SRMS | R0036 | BUS : RM Fresno - 06040
Job Category:
Claims
Job Code:
Sr Claim Examiner- WC:BS0160
Job Title:
Sr Claim Examiner- WC
Keywords:
Number of Positions:
1
Remaining Positions:
1
Duties:
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.
Skills:
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.
Education:
Bachelor's degree or equivalent experience. - Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization. Workers Compensation (WC) Adjuster License required according to jurisdictional requirements. Preferred: - Industry designations such as IIA, AIC, AEI and/or CPCU
Location
Client Location
Country:
United States
State/Province:
California
City:
Brea
Address:
675 Placentia Avenue, Suite 350, CA0001
POSTAL CODE:
92821
Work Location
Same as Client Location
Other Client Location
Work Completed Offsite
Schedule
Start Date:
08/31/2026
Hours Per Week:
40.00
Est. End Date:
12/01/2026
Hours Per Day:
8.00
Schedule Notes:
Days Per Week:
5.00
Part Time or Full Time:
Full Time
Attachment:
Can work Remote, supporting Pacific hours
Self Insured Certificate recommended – Good to have, not necessary
The examiner must be knowledgeable of local jurisdiction and Laws - certifications preferred where applicable. Duties –
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.
Skills –
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.
Education –
Bachelor's degree or equivalent experience.
Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization.
Workers Compensation (WC) Adjuster License required according to jurisdictional requirements.
PA/DE/MD/VA/DC
Preferred: - Industry designations such as IIA, AIC, AEI and/or CPCU
By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at Privacy Policy - Abacus.
Location
