Sr Claim Examiner-WC (CA)

Crawford•Fresno, CA

1d•Remote

About The Position

This is an exciting opportunity to join a global leader in claims management and make a meaningful impact through your expertise. We’re looking for a Senior Claims Examiner – Workers Compensation (California) with a passion for claims management to join our team! SIP certification is required. Proven experience handling California Workers Compensation claims. Strong background in managing advanced, large-loss, and complex cases. Investigate and settle advanced, large-loss, and complex claims promptly and equitably with minimal supervision. Work within established authority on moderate-to-difficult claims, reviewing coverages, determining liability/compensability, collecting statements and essential information, and settling claims using best practices. Evaluate and set reserves using independent judgment, support litigation preparation with supervisors and defense attorneys, and contribute to team development through training and mentorship.

Requirements

SIP certification is required
Proven experience handling California Workers Compensation claims
Strong background in managing advanced, large-loss, and complex cases
Bachelor's degree or equivalent experience required.
Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization.
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.
Effective advanced interpersonal skills to effectively interact with all levels of internal and external clients.
Workers Compensation (WC) Adjuster License required according to jurisdictional requirements

Nice To Haves

IIA, AIC, AEI, and/or CPCU.

Responsibilities

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.