Claims Examiner - Workers Compensation (1468687)

Adecco US, Inc. • Orange, CA • 13h ago

Adecco is assisting a local client recruiting for Claims Examiner Workers Compensation opportunities in ORANGE CA . This is an excellent opportunity to join a winning culture and get your foot in the third party claims administrator. They get hired to act as a claims administrator or claims adjuster by companies who are self-insured and don't have their own claims department. If Claims Examiner Workers Compensation sounds like something you would be interested in, and you meet the qualifications listed below, apply now!

Job Summary

The Workers' Compensation Claims Adjuster is responsible for analyzing and managing complex and technically challenging workers' compensation claims, including high-exposure and litigated files. This role ensures accurate benefit determination, timely claim resolution, compliance with statutory requirements, and adherence to client service standards and industry best practices. The adjuster will also identify and pursue subrogation opportunities and negotiate settlements within assigned authority.

Responsibilities:

Investigate, analyze, and process complex or high-exposure workers' compensation claims to determine compensability, liability, and financial exposure.

Develop and execute strategic action plans to drive claims toward timely and appropriate resolution.

Negotiate settlements and resolve claims within assigned authority levels.

Establish, monitor, and adjust claim reserves, ensuring ongoing reserve adequacy throughout the life of the claim.

Calculate and issue benefit payments accurately and timely; approve payment adjustments as applicable.

Prepare and submit required state filings within statutory timelines.

Manage litigated claims, coordinating with defense counsel and ensuring cost-effective resolution strategies.

Coordinate vendor services related to investigations, medical management, and litigation support.

Apply cost containment strategies, including effective use of vendor partnerships.

Manage claim recoveries, including:

Subrogation

Second Injury Fund recoveries

Social Security and Medicare offsets

Report claims to excess carriers and respond to requests promptly and professionally.

Communicate claim status and developments to claimants, clients, and internal stakeholders.

Maintain accurate and compliant claim documentation and coding.

Escalate complex issues or concerns to management as appropriate.

Required Skill

CA Workers' Compensation Adjuster Certification (required).

3+ years of relevant workers' compensation claims experience, including complex and/or litigated claims.

Bachelor's degree from an accredited college or university (preferred).

Strong knowledge of California workers' compensation laws and regulations.

Travel as required.

What's in this Claims Examiner Workers Compensation position for you?

Pay rate: $35/hr.

Location- ORANGE CA 92868 (Onsite)

Work Schedule: Mon - Fri 8AM - 5PM

Weekly paycheck.

Dedicated Onboarding Specialist & Recruiter.

Access to Adecco's Aspire Academy with thousands of free upskilling courses.

This Claims Examiner Workers Compensation is being recruited by one of our Centralized Delivery Team and not our local Branch. For instant consideration for this Claims Examiner Workers Compensation position and other opportunities with Adecco in ORANGE CA apply today!

Pay Details: $35.00 per hour

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the @type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

Military connected talent encouraged to apply

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.adecco.com/en-us/candidate-privacy

The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

The California Fair Chance Act

Los Angeles City Fair Chance Ordinance

Los Angeles County Fair Chance Ordinance for Employers

San Francisco Fair Chance Ordinance

Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

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