IconmaClaims Examiner - Workers Compensation (Hourly) IconmaClaims Examiner - Workers Compensation (Hourly)Brea, CA$43–$48 / hourResponsibilities:Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Health Source MSOClaims Auditor Health Source MSOClaims AuditorAlhambra, CAFull timeResponsibilities include, but not limited to: Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including:Contractual agreement rates. Job Description: Claims Auditor will be responsible for auditing claims processed by Claims Examiners.
JobotNewPartner/Senior Attorney - Civil Litigation Defense (Remote with California Bar) JobotPartner/Senior Attorney - Civil Litigation Defense (Remote with California Bar)West Los Angeles, CARemote$175,000–$225,000 / yearInformation collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. We strongly value a collegial environment and work-life balance, with a billing requirement of 1800 hours annually and remote work flexibility as well as a generous quarterly bonus structure for non-equity partners.
JobotInsurance Coverage Attorney — $185k to $275k + Bonus — Hybrid Remote — Regional Firm JobotInsurance Coverage Attorney — $185k to $275k + Bonus — Hybrid Remote — Regional FirmCosta Mesa, CARemote$185,000–$250,000 / yearThe Insurance Litigation & Coverage Group carries a national reputation representing domestic and international carriers in coverage disputes, bad faith litigation, and complex multi-insurer matters — from routine coverage questions to the most complex litigation in state and federal courts. Founded over 70 years ago, this California-based firm has built a national reputation representing domestic and international insurance companies across the full spectrum of coverage matters — backed by 90+ attorneys and growing across 7 offices and 27 practice groups.
Solugenix CorpSpecial Investigation Unit Investigator II Solugenix CorpSpecial Investigation Unit Investigator IILos Angeles, CA$43.29–$48.29 / hourTemporaryContractorFull timeAfter making a conditional offer and running a background check, if we are concerned about conviction that is directly related to the job, applicants will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. Minimum of 3 years of experience in healthcare fraud investigation/detection and/or healthcare related specialty including but not limited to; Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc.
Solugenix CorpSpecial Investigation Unit Investigator III Solugenix CorpSpecial Investigation Unit Investigator IIILos Angeles, CA$42.71–$55.53 / hourTemporaryContractorFull timeThe Special Investigation Unit Investigator III performs in-depth evaluation of potential fraud & abuse cases and develops complex investigations that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for fraud, waste & abuse. After making a conditional offer and running a background check, if we are concerned about conviction that is directly related to the job, applicants will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.
Solugenix CorpSIU Clinical Healthcare Fraud Investigator III Solugenix CorpSIU Clinical Healthcare Fraud Investigator IIILos Angeles, CA$45–$55.53 / hourTemporaryContractorFull timeThis position independently manages full-cycle investigations from intake through closure, develops investigative strategies, prepares evidentiary packages for regulatory or law enforcement referral, and provides clinical and operational insight into healthcare billing patterns and provider behaviors. Strong understanding of coding and reimbursement structures (including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding Systems (HCPCS), International Classification of Diseases (ICD-10)), medical billing, and claims review processes.
DB Insurance Co., Ltd.Claims Examiner (Hawaii) - HYBRID DB Insurance Co., Ltd.Claims Examiner (Hawaii) - HYBRIDAnaheim, CAFull timeThe ideal candidate will excel at collaborating with third-party adjusters, vendors, and industry experts to ensure claims are handled efficiently and accurately while delivering exceptional service to agents and claimants. This role involves overseeing and managing complex property and casualty claims, including those related to building and structural damage, auto, and workers’ compensation.
W. R. Berkley CorpSenior Claims Examiner W. R. Berkley CorpSenior Claims ExaminerIrvine, CA$110,000–$125,000 / yearThis role actively supports and participates in the company's culture of continuous learning and innovation, including engagement in innovation groups focused on identifying opportunities for process improvement, enhancement, and transformational change. Key functions include but are not limited to: Adjust all aspects of complex claims and loss notices, including coverage and compensability analysis, reserve setting, reinsurance reporting, and coverage litigation.
MedPOINT ManagementHospital Claims Examiner MedPOINT ManagementHospital Claims ExaminerSherman Oaks, CARemoteAdhere to MedPOINT Management’s core values: Accountability, Community, Celebration, Integrity, Innovation & Collaboration. Researches, reviews and contacts provider services for problem claims and issues, as needed.
MedPOINT ManagementClaims Examiner MedPOINT ManagementClaims ExaminerSherman Oaks, CARemoteAdhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration. Researches, reviews and contacts provider services for problem claims and issues, as needed.
DB Insurance Co.Claims Examiner (Hawaii) - HYBRID DB Insurance Co.Claims Examiner (Hawaii) - HYBRIDAnaheim, CaliforniaThe ideal candidate will excel at collaborating with third-party adjusters, vendors, and industry experts to ensure claims are handled efficiently and accurately while delivering exceptional service to agents and claimants. This role involves overseeing and managing complex property and casualty claims, including those related to building and structural damage, auto, and workers’ compensation.
Huntington HospitalMedical Malpractice Claims Examiner Huntington HospitalMedical Malpractice Claims ExaminerPasadena, CA$84,240–$126,360 / yearThis role ensures timely and accurate claims handling in accordance with applicable laws, organizational policies, and insurance coverage requirements, while mitigating financial and reputational risk to the organization. Proven experience in the handling of professional liability, employment liability, and general liability claims, and interacting with medical staff, legal counsel, risk managers, and insurance carriers.
Markel Group IncSenior Claims Examiner, Management Liability, Markel Group IncSenior Claims Examiner, Management Liability,Woodland Hills, CA$78,000–$107,250 / yearThis includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Manage litigation filed nationwide against insureds; appoint, direct, and manage defense counsel; proactively work toward expeditious and economical resolution of claims; assist internal claims vendor management, disbursement and legal collections teams with defense counsel, bill payment, and collection issues.
BerkleySenior Claims Examiner BerkleySenior Claims ExaminerIrvine, California$110,000–$125,000 / yearThis role actively supports and participates in the company’s culture of continuous learning and innovation, including engagement in innovation groups focused on identifying opportunities for process improvement, enhancement, and transformational change. Key functions include but are not limited to: Adjust all aspects of complex claims and loss notices, including coverage and compensability analysis, reserve setting, reinsurance reporting, and coverage litigation.
Cedars-Sinai Medical CenterClaims Examiner - Managed Care Cedars-Sinai Medical CenterClaims Examiner - Managed CareLos Angeles, CAExperience: Three (3) years of medical claims processing for Medicare and Commercial products and provider dispute resolution processing in an IPA, HMO and Hospital related setting required. Acquires and adjudicates medical claims for processing; reviews scanned, EDI, or manual documents for pertinent data on claim for complete and accurate information.
ICONMA, LLCClaims Examiner - Workers Compensation (Hourly) ICONMA, LLCClaims Examiner - Workers Compensation (Hourly)Brea, CA$43–$48 / hourResponsibilities:Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Ultimate Staffing ServicesHealth Claims Examiner Ultimate Staffing ServicesHealth Claims ExaminerPasadena, California$24–$28 / hourCommunicate professionally with members and providers to resolve inquiries, follow up on pended claims, and complete corrections or adjustments. This position is ideal for someone who enjoys problem‑solving, working with complex benefit plans, and collaborating with both internal teams and external partners.
U.S. Department of Veterans AffairsNewVeterans Claims Examiner U.S. Department of Veterans AffairsVeterans Claims ExaminerCARemote$40,736–$65,599 / yearCustomer Service: Works with clients and customers (that is, any individuals who use or receive the services or products that your work unit produces, including the general public, individuals who work in the agency, other agencies, or organizations outside the Government) to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations; knows about available products and services; is committed to providing quality products and services. Education/Certification/ Licensure: When relevant or required for the position, include your possession of education/ certification/license and provide any required documentation such as transcripts, and/or details (type and date) of certifications and/or licenses.
Welbe Health LLCClaims Examiner Welbe Health LLCClaims ExaminerCA$55,930.55–$73,828.33 / yearOur Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Examiner plays a pivotal role in ensuring timely and efficient processing of claims for our contracted specialty provider partners. Understanding of Industry pricing methodologies, such as Medicare/Medi-Cal fee schedule, Diagnosis Related Groups (DRG), Multiple Procedure Payment Reduction (MPPR) and benefit interpretation and administration .
ICW GroupWorkers' Compensation Senior Claims Examiner ICW GroupWorkers' Compensation Senior Claims ExaminerWoodland Hills, CA$68,481.25–$115,489.01 / yearHeadquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.
Ultimate Staffing ServicesMedical Claims Examiner Ultimate Staffing ServicesMedical Claims ExaminerPasadena, California$26–$29 / hourWe are seeking an experienced Medical Claims Examiner to review, analyze, and adjudicate medical claims for accuracy, compliance, and medical necessity. Identify coding discrepancies, overpayments, and potential fraud or abuse.
BesticaNewNon-Clinical - Finance/Accounting - Claims Examiner BesticaNon-Clinical - Finance/Accounting - Claims ExaminerWhittier, CAMinimum of 2 years claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environment Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services * Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims * Knowledge of compliance issues as they relate to claims processing Experience in interpreting provider contract reimbursement terms desirable Ability to identify non-contracted providers for Letter of Agreement consideration Data entry experience Training on basic office automation and managed care computer systems RTO MUST BE SUBMITTED AT TIME OF SUBMITTAL, NO EXCEPTIONS They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.
ICONMA, LLCClaims Examiner - Workers Compensation ICONMA, LLCClaims Examiner - Workers CompensationLong Beach, CA$45–$50 / hourMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Apidel TechnologiesClaims Examiner - Workers Compensation Apidel TechnologiesClaims Examiner - Workers CompensationPasadena, CARemoteContractorPrimary purpose: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Ultimate Staffing ServicesHealthcare Claims Examiner Ultimate Staffing ServicesHealthcare Claims ExaminerEl Monte, California$25–$28 / hourResearch and resolve claim discrepancies, including making payment corrections, recovering overpayments, and reprocessing claims as needed. Evaluate claims for potential fraud, waste, abuse, Workers' Compensation, hospital-acquired conditions, and third-party liability; escalate issues appropriately.
AllSearch Professional Staffing Inc.Claims Examiner - Property and Casualty Insurance - Base Salary to 90k/year - Anaheim, CA AllSearch Professional Staffing Inc.Claims Examiner - Property and Casualty Insurance - Base Salary to 90k/year - Anaheim, CAAnaheim, CA$60,000–$90,000 / yearThis position is ideal for an insurance professional with experience handling property and casualty claims who enjoys analytical problem-solving, claim investigations, and working with multiple stakeholders to achieve timely and accurate claim resolution. The Claims Examiner will collaborate with third-party administrators, adjusters, vendors, and technical experts to investigate claims, evaluate coverage, determine liability, and negotiate settlements.
AllSearch Professional StaffingThird Party Liability Claims Examiner - Insurance Carrier - Base Salary to 100k/year - Anaheim, CA AllSearch Professional StaffingThird Party Liability Claims Examiner - Insurance Carrier - Base Salary to 100k/year - Anaheim, CAAnaheim, CA$60,000–$100,000 / yearOur client, a large and growing insurance carrier, is seeking a Third Party Liability Claims Examiner to manage complex bodily injury, property damage, and litigated liability claims related to commercial trucking and business insurance policies. This role is responsible for investigating, evaluating, negotiating, and resolving third-party liability claims while coordinating with attorneys, TPAs, claimants, and internal teams.
IconmaClaims Examiner - Workers Compensation IconmaClaims Examiner - Workers CompensationLong Beach, CA$45–$50 / hourMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Markel Group IncSenior Claims Examiner, Medical & Healthcare Claims Markel Group IncSenior Claims Examiner, Medical & Healthcare ClaimsWoodland Hills, CAThis includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. The primary purpose of this job is to handle claims from coverage enquiry through legal liability assessment (where relevant) and quantum analysis, to timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all internal and external stakeholders.
eTeam Inc.Claims Examiner - Workers Compensation eTeam Inc.Claims Examiner - Workers CompensationLong Beach, CA$45–$50 / hourPRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
MindlanceClaims Examiner - Workers Compensation MindlanceClaims Examiner - Workers CompensationPasadena, CARemote$52.57–$53.57 / hourPRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
US Tech Solutions, Inc.NewClaims Examiner # 26-14108 US Tech Solutions, Inc.Claims Examiner # 26-14108Whittier, CA$23–$25 / hourThey are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients. US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.
Howden Group Holdings LtdSr. Casualy Claims Examiner Howden Group Holdings LtdSr. Casualy Claims ExaminerCARemote$125,000–$145,000 / hourDraft well written and comprehensive captioned reports to request reserve and settlement authority on higher exposure cases that outline all critical aspects of the case in preparation for roundtable presentations to the carrier partners. Supporting the Construct Defect Claims team, you will independently manage moderate to high exposure claims involving alleged defects in residential and commercial construction.
Howden Group Holdings LtdSr. Casualty Claims Examiner Construction Howden Group Holdings LtdSr. Casualty Claims Examiner ConstructionCA$125,000–$145,000 / yearDraft well written and comprehensive captioned reports to request reserve and settlement authority on higher exposure cases that outline all critical aspects of the case in preparation for roundtable presentations to the carrier partners. Supporting the Construct Defect Claims team, you will independently manage moderate to high exposure claims involving alleged defects in residential and commercial construction.
Sedgwick Claims Management Services, Inc.NewAuto & Bodily Injury Litigation Claims Examiner | Commercial Auto | Dedicated Client & Capped Caseload License Required Sedgwick Claims Management Services, Inc.Auto & Bodily Injury Litigation Claims Examiner | Commercial Auto | Dedicated Client & Capped Caseload License RequiredTelecommuter, CARemote$85,000–$95,000 / yearMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. PRIMARY PURPOSE OF THE ROLE To analyze Auto Bodily Injury Litigation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Sedgwick Claims Management Services, Inc.NewWorkers Compensation Claims Examiner | HYBRID | Brea, CA Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | HYBRID | Brea, CABrea, CARemote$80,000–$105,000 / yearMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. PRIMARY PURPOSE OF THE ROLE To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | Bonus Eligible | Long Beach or Roseville, CA Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | Bonus Eligible | Long Beach or Roseville, CALong Beach, CA$80,000–$100,000 / yearPRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.
Sedgwick Claims Management Services, Inc.Claims Examiner Workers'''' Compensation Sedgwick Claims Management Services, Inc.Claims Examiner Workers'''' CompensationCA$60,234–$85,000 / yearTo analyze workers compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | Roseville or Long Beach, CA Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | Roseville or Long Beach, CALong Beach, CA$80,000–$98,000 / yearMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. PRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Sedgwick Claims Management Services, Inc.Claims Examiner- Workers Compensation | Brea, CA (Hybrid) Sedgwick Claims Management Services, Inc.Claims Examiner- Workers Compensation | Brea, CA (Hybrid)Brea, CARemote$85,000–$105,000 / yearPRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Sedgwick Claims Management Services, Inc.Claims Examiner - Workers Compensation (West Hills,CA/Remote 3 days) Sedgwick Claims Management Services, Inc.Claims Examiner - Workers Compensation (West Hills,CA/Remote 3 days)West Hills, CARemote$80,000–$98,000 / yearPRIMARY PURPOSE OF THE ROLE: To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.
Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | Long Beach or Roseville, CA Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | Long Beach or Roseville, CALong Beach, CA$85,000–$105,000 / yearMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. PRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Sedgwick Claims Management Services, Inc.Claims Examiner, Auto | Bodily Injury Sedgwick Claims Management Services, Inc.Claims Examiner, Auto | Bodily InjuryMSEducation & Licensing: Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverages, principles, and laws. Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
Sedgwick Claims Management Services, Inc.Claims Examiner - Workers Compensation | Glendale, CA - Hybrid Sedgwick Claims Management Services, Inc.Claims Examiner - Workers Compensation | Glendale, CA - HybridGlendale, CA$72,914–$85,000 / yearPRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.
Markel Group IncClaims Examiner II, Lawyers and Financial Advisors Markel Group IncClaims Examiner II, Lawyers and Financial AdvisorsWoodland Hills, CAThis includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Manage litigation filed nationwide against insureds; appoint, direct and manage defense counsel; proactively work toward expeditious and economical resolution of claims; assist Company claims vendor management, disbursement and legal collections teams with defense counsel, bill payment and collection issues.
MindlanceClaims Examiner - Workers Compensation (Hourly) MindlanceClaims Examiner - Workers Compensation (Hourly)Brea, CARemote$47–$48 / hourDuties: PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
ObjectWin TechnologyClaims Examiner - Workers Compensation ObjectWin TechnologyClaims Examiner - Workers CompensationBrea, CA, CATo analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Sedgwick Claims Management Services, Inc.Claims Examiner - Workers Compensation w/CALI Experience Sedgwick Claims Management Services, Inc.Claims Examiner - Workers Compensation w/CALI ExperienceTelecommuter, CA$72,914–$95,000 / yearPRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Sedgwick Claims Management Services, Inc.Claims Examiner - Workers Compensation Sedgwick Claims Management Services, Inc.Claims Examiner - Workers CompensationLong Beach, CA$72,914–$90,000 / yearAnalyzes and processes complex or technically difficult workers compensation claims by investigating and gathering information to determine the exposure on the claim; • Manages claims through well-developed action plans to an appropriate and timely resolution; • Negotiates settlement of claims within designated authority; • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim; • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level; • Prepares necessary state filings within statutory limits; • Manages the litigation process; ensures timely and cost-effective claims resolution; • Coordinates vendor referrals for additional investigation and/or litigation management; • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients; • Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets; • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner; • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships; • Ensures claim files are properly documented and claims coding is correct; • Refers cases as appropriate to supervisor and management; • Performs other duties as assigned; • Supports the organizations quality program(s); • Travels as required. To analyze complex or technically difficult workers compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.