Sr. Claims Examiner (Onsite, Roseville)

About the role

Adventist Health Roseville is seeking a Senior Claims Examiner for a full-time, day shift position. Located in the Sacramento metropolitan area, the corporate headquarters of Adventist Health have been based in Roseville, California, for over 40 years. In 2019, the organization unveiled its WELL-certified campus, a rejuvenating space for associates systemwide to collaborate, innovate, and connect. Adventist Health Roseville and shared service teams have access to this welcoming environment designed to promote well-being and inspire the best work.

Responsibilities

• Analyzes complex and/or technically challenging medical malpractice/general liability claims and resolves complex and/or severe injury claims.
• Captures the need for and retains experts to evaluate the standard of care/damages.
• Develops, updates, and executes case-specific investigation plans and negotiates settlements of the claim.
• Applies advanced technical knowledge to solve complex problems for a department.
• Coordinates legal defense by assigning counsel, coordinating support for investigations.
• Reviews attorney invoices and monitors counsel for compliance with organization policies and guidelines.
• Calculates and assigns timely and appropriate reserves for claims. Monitors reserve adequacy throughout the life of the claim.
• Recommends and implements settlement strategies. Involves structured settlement professionals as necessary to maximize settlement and identifies opportunities for subrogation, contribution, recovery, and other case management opportunities to mitigate total claim costs.
• Ensures claim file documentation is timely and accurate. Creates initial notice to reinsurers and provides timely updates on case status.
• Performs other job-related duties as assigned.

Requirements

• Education and Work Experience: Bachelor's degree or equivalent combination of education/related experience.
• Master's Degree or Juris Doctor: Preferred.
• Seven years' liability claims management experience: Preferred.
• One year's leadership experience: Preferred.
• Experience with legal matters and complex litigation: Preferred.

Essential Functions

• Analyzes nature and extent of investigation necessary to evaluate liability and damages.
• Determines the need for and retains experts to evaluate the standard of care/damages.
• Develops, updates, and executes case-specific investigation plan and negotiates settlement of the claim.
• Applies advanced technical knowledge to solve complex problems for a department.
• Captures the need for and retains experts to evaluate the standard of care/damages.
• Develops, updates, and executes case-specific investigation plans and negotiates settlements of the claim.
• Applies advanced technical knowledge to solve complex problems for a department.
• Coordinates legal defense by assigning counsel, coordinating support for investigations.
• Reviews attorney invoices and monitors counsel for compliance with organization policies and guidelines.
• Calculates and assigns timely and appropriate reserves for claims. Monitors reserve adequacy throughout the life of the claim.
• Recommends and implements settlement strategies. Involves structured settlement professionals as necessary to maximize settlement and identifies opportunities for subrogation, contribution, recovery, and other case management opportunities to mitigate total claim costs.
• Ensures claim file documentation is timely and accurate. Creates initial notice to reinsurers and provides timely updates on case status.
• Performs other job-related duties as assigned.

Organizational Requirements

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit here for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

About Us

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness, and hope.

JOB INFO

Job Identification : L52069-2
Job Category : Manager
Posting Date : 2026-03-27T23:02:29+00:00
Job Shift : Day Shift
Locations : Roseville, CA, United States
Assignment Category : Full-time regular
Pay Range : The estimated base pay for this position is $120,077 to $180,115. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information.