CERTIFIED WORKER'S COMPENSATION CLAIMS EXAMINER
Occupations:
Claims Adjusters, Examiners, and InvestigatorsInsurance Claims and Policy Processing ClerksInsurance Appraisers, Auto DamageCompensation, Benefits, and Job Analysis SpecialistsInsurance UnderwritersIndustries:
Administration of Human Resource ProgramsAgencies, Brokerages, and Other Insurance Related ActivitiesLime and Gypsum Product ManufacturingInsurance CarriersPesticide, Fertilizer, and Other Agricultural Chemical ManufacturingWe are seeking a motivated individual and certified claims examiner for this role.Schedule:Monday – Friday 8:00 am to 5:00 pm.Location: On-site in Martinez, CA (Posibility of hybrid after training)Requirements:* Certification: Must be a current Certified Claims Adjuster in the State of California pursuant to Title 10 of CCR2592 or possess the Self-Insurance Certificate issued by the State of California.* Education: Completion of 60 semester or 90 quarter units from an accredited college or university, including at least six semester or nine quarter units in business, public administration, insurance, physical science, finance, or a closely related field.*Substitution: Additional experience may be substituted for education on a year-for-year basis, up to two (2) years.*Experience: Minimum of three (3) years of full-time work as a Workers' Compensation Claims Adjuster I or in an equivalent role with an insurance carrier or third-party claims administrator focused on workers' compensation indemnity claims.Knowledge, Skills, and Abilities:1. Strong understanding of Workers' Compensation insurance principles, legal statutes, and civil procedures.2. Familiarity with medical and legal terminology, Medicare Set-asides, and the Americans with Disabilities Act (ADA).3. Ability to interpret legal statutes, analyze evidence, prioritize claims, and calculate benefits accurately.4. Experience in maintaining effective working relationships with stakeholders (employers, physicians, attorneys, etc.).5. Skilled in preparing clear, concise reports and oral presentations.6. Proficient in documenting work using Workers' Compensation Claims software and managing electronic claim files.Typical Tasks:Investigating and adjusting job-related injury claims, making determinations regarding compensability, medical treatment, disability compensation, and death benefits.Interviewing claimants, witnesses, supervisors, and physicians to assess claim credibility.Assisting legal counsel in case development, settlement negotiations, and Workers' Compensation Appeals Board representation when necessary.Preparing reports, correspondence, and maintaining accurate claim files.Managing referrals to ADA Coordinators and monitoring alternative work programs.Collaborating with external vendors for utilization review and handling excess insurance cases.