Workers' Compensation Claims Examiner

Location: Sacramento, CA | Work Arrangement: Hybrid | Employment Type: Full-Time

Schedule

Monday - Friday, 8:00 AM - 5:00 PM

Pay

$38.00 - $45.00 per hour

About the role

We are seeking an experienced Workers' Compensation Claims Examiner to manage a caseload of complex and litigated California workers' compensation claims. This hybrid opportunity is ideal for someone who can work independently, make sound claim decisions, and build strong relationships with clients, attorneys, medical providers, and other stakeholders.

Workers' Compensation Claims Examiner experience and SIP experience are required. Candidates without both will not be considered.

Responsibilities

• Manage complex and litigated workers' compensation claims from inception through resolution
• Investigate claims and determine compensability
• Administer benefits in accordance with California workers' compensation regulations
• Review and authorize medical treatment and related expenses
• Establish and maintain claim reserves
• Negotiate settlements and obtain required approvals
• Partner with defense attorneys on litigated claims
• Maintain accurate claim notes, documentation, and diary activities
• Communicate claim status and recommendations with clients
• Identify subrogation opportunities and pursue recoveries
• Assist with audits, regulatory reporting, and compliance requirements
• Provide guidance and support to junior claims professionals

Requirements

• Minimum of 5 years of Workers' Compensation Claims Examiner experience
• SIP experience required
• Experience handling California workers' compensation claims
• Strong background managing litigated indemnity claims
• Experience establishing reserves and negotiating settlements
• Knowledge of workers' compensation laws, regulations, and medical terminology
• Strong written, verbal, and client communication skills
• Ability to manage a caseload independently
• Proficiency with Microsoft Word and Excel