Workers Compensation Claims Examiner

Job Description

Job Description

Job Profile

Job Title: Claims Examiner

Location: Long Beach, CA

Hire Type: Contingent

Pay Range: $46.97 - $53.33 per/Hr.

Work Model: Onsite

Work Shift: Monday-Friday 8 am – 4:30 pm

Recruiter Contact: Sean Craft I [email protected] I 443-345-3305

Nature & Scope:

Positional Overview

We are seeking an experienced Claims Examiner – Workers’ Compensation to join our team onsite in Long Beach, CA. This role focuses on analyzing and processing complex or technically challenging workers’ compensation claims. The ideal candidate will have experience in high-exposure claims involving litigation and rehabilitation, with a strong grasp of California WC regulations and cost containment strategies.

Applicants should have a minimum of 2 years’ experience in Workers’ Compensation claims handling. Possession of relevant certifications such as WCCA or a Self-Insurance Plan (SIP) license is highly preferred.

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Role & Responsibility:

Tasks That Will Lead to Your Success

· Analyze and process complex or technically difficult WC claims by investigating facts and determining claim exposure.

· Manage claims with well-developed action plans aimed at achieving timely and appropriate resolution.

· Negotiate and settle claims within designated authority.

· Calculate and assign appropriate reserves; ensure ongoing reserve adequacy.

· Process and approve benefit payments and claim adjustments promptly.

· Manage the litigation process, including communication with attorneys and external vendors.

· Coordinate vendor referrals for investigations and litigation management as needed.

· Apply cost containment strategies including utilization of preferred vendor networks.

· Handle recovery efforts such as subrogation, Second Injury Fund (SIF) claims, and Medicare offsets.

· Report high exposure claims to excess carriers and respond professionally to direction.

· Ensure all necessary state filings are completed within statutory timeframes.

· Maintain accurate documentation and correct claim coding within file systems.

· Communicate effectively with claimants, clients, and internal teams.

· Refer cases to supervisors or managers as appropriate.

Skills & Experience

Qualifications That Will Help You Thrive

· Bachelor’s degree from an accredited college or university is required.

· Professional certifications (e.g., WCCA, SIP) strongly preferred.

· Minimum 2 years of Workers’ Compensation claims handling experience required.

· Experience with high exposure or litigated claims is highly desired.

· Deep knowledge of California WC laws, regulations, and adjudication processes.

· Familiarity with cost containment strategies, disability durations, and Medicare/Social Security procedures.

· Strong negotiation, organizational, and analytical skills.

· Excellent verbal and written communication, including report and presentation development.

· Computer proficiency includes MS Office and claims management systems.

· Ability to manage multiple claims with high accuracy under deadline pressures.

· Professionalism in maintaining client relationships and confidentiality.

Company Description

Mary Kraft HR was founded in 1989 by Maryland native Mary Kraft and has since partnered with industry-leading companies in healthcare, financial, commercial, insurance, and service industry. As of February 2022, we celebrated 33 years as a small but mighty family-owned business. We are also proud to announce that for the last 5 consecutive years we have received Best in Staffing’s Client and Talent Diamond Awards.

We’re here to make sure you get placed in a job that suits your needs and skills and offers the resources you need to advance your career. We offer medical, dental, vision, and 401K.

Company Description

Mary Kraft HR was founded in 1989 by Maryland native Mary Kraft and has since partnered with industry-leading companies in healthcare, financial, commercial, insurance, and service industry. As of February 2022, we celebrated 33 years as a small but mighty family-owned business. We are also proud to announce that for the last 5 consecutive years we have received Best in Staffing’s Client and Talent Diamond Awards.\r\n\r\nWe’re here to make sure you get placed in a job that suits your needs and skills and offers the resources you need to advance your career. We offer medical, dental, vision, and 401K.