Workers Compensation Claims Examiner

Job Profile
Job Title	Workers Compensation Claims Examiner
Location	Remote
Hire Type	Contingent
Hourly	$50
Work Model	Monday – Friday
Contact Phone	(443)-345-3305
Contact Email	sean@marykraft.com

Nature & Scope:

Positional Overview

Mary Kraft is seeking an experienced Workers Compensation Claims Examiner to join our team. The ideal candidate will analyze complex workers’ compensation claims, determine benefits due, and manage high-exposure cases involving litigation and rehabilitation. This role requires expertise in California Workers’ Compensation laws, strong negotiation skills, and the ability to ensure claims are handled in compliance with industry best practices and client requirements.

Role & Responsibility:

Tasks That Will Lead To Your Success

Investigate, analyze, and process complex workers’ compensation claims to determine exposure and benefit eligibility.
Develop and implement action plans to ensure appropriate and timely resolution of claims.
Calculate and assign reserves, ensuring reserve adequacy throughout the claim lifecycle.
Approve and process benefit payments, adjustments, and settlements within designated authority levels.
Prepare and submit required state filings within statutory limits.
Manage litigation processes and work towards cost-effective claim resolution.
Negotiate claim settlements while adhering to company and client guidelines.
Coordinate vendor referrals for additional investigations and legal support.
Utilize cost-containment techniques and strategic vendor partnerships to minimize claim expenses.
Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security/Medicare offsets.
Report claims to excess carriers and respond promptly to direction requests.
Maintain professional relationships with claimants, clients, and internal teams.
Provide timely updates and ensure clear communication regarding claim status and decisions.
Ensure proper claim documentation and accurate coding

Skills & Experience:

Qualifications That Will Help You Thrive

Minimum of 3 years of relevant California Workers' Compensation experience (5+ years preferred).
SIP certification is mandatory.
Strong understanding of California Workers' Compensation laws, disability management, and cost-containment practices.
Excellent verbal and written communication skills
Strong analytical and decision-making abilities
Proficiency in Microsoft Office and claims management systems
Effective negotiation and problem-solving skills
Ability to work independently and collaboratively within a team