Sr Claim Examiner-WC (CA)
About the position We’re Hiring: Senior Claims Examiner – Workers Compensation (California) This is an exciting opportunity to join a global leader in claims management and make a meaningful impact through your expertise. Why You’ll Love It Here: Offers Work From Home Position Salary: $52,309.37 – $95,657.13 Annually Excellent Crawford Benefits Supporting Financial, Physical & Mental Wellness Great Bonus Opportunity Generous Employee Referral Bonus Program ️ Access to Multiple Employee Discounts 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 Role Overview: 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.
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.
Requirements
- 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
- SIP certification is required
- Proven experience handling California Workers Compensation claims
- Strong background in managing advanced, large-loss, and complex cases
Nice-to-haves
- Preferred: IIA, AIC, AEI, and/or CPCU.
Benefits
- Offers Work From Home Position
- Salary: $52,309.37 – $95,657.13 Annually
- Excellent Crawford Benefits Supporting Financial, Physical & Mental Wellness
- Great Bonus Opportunity
- Generous Employee Referral Bonus Program
- Access to Multiple Employee Discounts
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