Imagine Staffing Technology, An Imagine Company · 1 week ago
Claims Examiner - Liability
Orange, CA, US
Full-time
Onsite
Mid Level
$52/hr - $52/hr
3+ years expImagine Staffing Technology is seeking an experienced Workers’ Compensation Claims Examiner to manage complex and technically difficult claims. The role involves determining compensability and benefits, managing high-exposure claims, and ensuring timely and accurate adjudication in accordance with company standards.
Human ResourcesInformation Technology
Responsibilities
Analyze and process complex or technically difficult workers’ compensation claims by investigating facts, gathering documentation, and determining claim exposure
Develop and execute detailed action plans to ensure timely and appropriate claim resolution
Negotiate claim settlements within assigned authority levels
Establish, monitor, and adjust claim reserves to ensure reserve adequacy throughout the life of the claim
Calculate and authorize benefit payments, claim adjustments, and settlements in a timely manner
Prepare and submit required state filings within statutory guidelines
Manage litigated claims to ensure timely and cost-effective resolution
Coordinate vendor referrals for investigations, medical management, and litigation support
Apply cost containment strategies, including the use of strategic vendor partnerships, to reduce overall claim costs
Manage claim recoveries, including subrogation, Second Injury Fund recoveries, and applicable Social Security and Medicare offsets
Report claims to excess carriers and respond to direction requests promptly and professionally
Communicate claim activity, decisions, and status with claimants and clients while maintaining strong professional relationships
Ensure claim files are accurately documented and claims coding is complete and compliant
Escalate complex or high-risk cases to supervisors or management as appropriate
Qualification
Required
High School Diploma or GED required
California Adjuster Certification required
Minimum three (3) years of relevant workers' compensation claims experience required
Strong knowledge of workers' compensation insurance principles, laws, and regulations
Excellent verbal and written communication and presentation skills
Strong analytical, interpretive, and organizational abilities
Excellent negotiation and interpersonal skills
Proficiency with Microsoft Office and claims management systems
Ability to work independently and collaboratively in a team environment
Preferred
Bachelor's degree from an accredited college or university preferred
Professional certification related to workers' compensation claims preferred
Experience handling complex, high-exposure, and litigated claims preferred
Expertise in recoveries, offsets, deductions, claim duration analysis, and cost containment strategies
Familiarity with medical management practices and Social Security and Medicare application procedures
Company
Imagine Staffing Technology, An Imagine Company
As one of the nation’s largest third-party recruitment firms, Imagine Staffing Technology is dedicated to delivering exceptional staffing solutions to answer the talent demands of our clients.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Gia Manley
Chief Executive Officer
Company data provided by crunchbase