Workers' Compensation Claims Examiner Sr.

Company Name:
Essential Staffing, Inc.
The Senior Workers Compensation Examiner is responsible for the analysis and management of complex workers compensation claims. This position will review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims. The position will process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. Acts in a fiduciary role on behalf of policyholders, negotiates claim settlements and manages subrogation. Senior Claims Examiners conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California. The Senior Workers Compensation Examiner is expected to function with a degree of competency. The use of sound judgment coupled with consistent results is expected.
The quality of 3 point contacts and addressing of such issues as coverage, compensability, delay and/or denial of claim.
The establishment and/or amendment of reserves using the philosophy of most likely outcome.
The establishment, documentation, and execution of action plans.

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