Claims Examiner (Workers’ Compensation)
Position Summary
Our client is seeking an experienced Claims Examiner to independently manage a full-cycle caseload of workers’ compensation claim from inception through resolution. This role requires strong technical expertise, sound judgment, and the ability to handle highly complex indemnity claims within established authority limits.
This is a highly interactive role requiring regular communication with clients, claimants, attorneys, medical providers, and internal stakeholders. Consistent, reliable attendance and strong organizational discipline are essential to success.
Key Responsibilities
Manage a caseload of 150–180 workers’ compensation claims, including complex indemnity cases
Conduct timely and thorough investigations to determine claim compensability
Administer benefits in accordance with state regulations and company guidelines
Oversee medical treatment plans and authorize medical services and billing as appropriate
Coordinate with and manage defense counsel on litigated claims
Communicate effectively with claimants, providers, vendors, and clients regarding claim status and issues
Establish and maintain appropriate claim reserves within authority guidelines
Negotiate and finalize claim settlements within designated authority levels
Maintain accurate and up-to-date claim documentation and diary systems
Provide clients with timely updates, including injury trends and risk insights
Conduct independent file reviews and ensure compliance with internal policies
Perform additional duties as assigned
Qualifications
Education & Experience
Bachelor’s degree in a related field (preferred)
5+ years of workers’ compensation claims experience or equivalent combination of education and experience
Must have an active California SIP certification - Self Insurance Plans)
Knowledge, Skills & Abilities
Strong knowledge of workers’ compensation laws and regulations
Familiarity with medical terminology and claims processes
Excellent analytical and problem-solving skills
Strong written and verbal communication skills
Ability to manage high-volume, complex caseloads independently
Proficiency in Microsoft Office (Word, Excel preferred)
Ability to collaborate effectively with stakeholders at all levels
Certifications
Relevant state licenses and/or certifications as required
Work Environment & Physical Requirements
Primarily office-based role requiring extended periods of sitting and computer use
Frequent communication via phone and email
Occasional light physical activity (lifting, reaching, etc.) consistent with a standard office environment
Why This Opportunity Stands Out
This is not an entry-level examiner role. If you’re used to handling basic claims, you’ll get exposed here. This role is built for someone who:
Wants ownership of complex files
Is confident making decisions within authority
Can handle volume without sacrificing quality
If that’s you, this is a strong platform to grow and be recognized.
If you're interested, please reply to this advertisement or directly email your resume to me at DSalgado@teemagroup.com or by calling/texting (949) 295-5951.
I strive to reply within 48 hours. Looking forward to connecting with you soon. Thank you!