Job Description
Job Description
Location: Sacramento – Rancho Cordova, CA 95670
Salary Range: $80,000–$99,000
Employment Type: Full-Time, Experienced Level
Position Type: Hybrid
Position Summary
We are seeking an experienced Claims Examiner III to manage all aspects of Workers’ Compensation claims (complex, litigated, non-disabling) from inception to conclusion within established authority and guidelines. This hybrid role will support a floating or permanent caseload to cover vacations, leaves of absence, onboarding, increased pending inventories, audits, and other operational needs.
Under the direction of the Claims Supervisor and/or Manager, the Claims Examiner III interacts extensively with clients, claimants, medical providers, attorneys, vendors, nurse and vocational case managers, and other company staff.
Duties and Responsibilities
- Manage a temporary or assigned caseload of Workers’ Compensation claims, including complex and litigated files
- Initiate and conduct timely investigations of claims
- Determine compensability and administer benefits based on state law and Best Practices
- Manage medical treatment and billing, authorizing as appropriate
- Refer cases to outside defense counsel and participate in litigated matters
- Communicate with claimants, attorneys, providers, and vendors regarding claims issues
- Maintain organized and proactive workflow, including diary system for case reviews and documentation
- Compute and set reserves within company guidelines
- Settle and finalize claims, obtaining required authority
- Identify claims for apportionment, subrogation, and excess reporting as applicable
- Assist with state audit and reporting requirements
- Mentor less experienced examiners
- Other duties as assigned, including claims management for other jurisdictional workers’ compensation claims
- Adhere to all company policies and procedures
Qualifications
- Minimum 5 years of related experience, or equivalent combination of education and experience
- Technical knowledge of statutory regulations and medical terminology
- Strong analytical, written, and verbal communication skills
- Ability to independently manage complex claims and interact at all levels of the organization
- Proficient in Microsoft Word and Excel (preferred)
- Licenses / Certifications: California Self-Insurance Certificate or applicable jurisdiction requirements
Equipment / Work Environment
- Operates computer, 10-key, fax machine, copier, printer, and other office equipment
- Appropriate office attire required
Benefits
- Medical, Dental, Vision Insurance
- Life and Disability Insurance
- 401(k) Plan
- Paid Holidays and Paid Time Off