Claims Examiner - Workers Compensation

Claims Examiner - Workers Compensation

BCForward is looking for Workers' Compensation Claims Examiner at (California - Remote/Hybrid)

Position Title: Workers' Compensation Claims Examiner (California - Remote/Hybrid
Location: Remote within California (Hybrid option available near San Diego or Roseville offices)
Anticipated Start Date: 4/21/2025Expected Duration: 04 Months of contract with possible extension
Job Type: [FULL TIME (>=40 HRS WEEKLY], [CONTRACT], [Onsite]
Shift timing: 37.5 hours/week. Flexible on start/end times (can do as early as 7am).
Pay Range: $50.00/hr.

Position Summary:

We are seeking a skilled Workers' Compensation Claims Examiner to manage complex and high-exposure California workers' compensation claims. This role requires at least 3 years of direct CA claims handling experience and offers the flexibility of remote work within California, with a preference for candidates near San Diego or Roseville for hybrid options. The ideal candidate will have deep knowledge of CA claims regulations, excellent analytical and negotiation skills, and a strong commitment to delivering high-quality results.

Key Responsibilities:

• Investigate, analyze, and manage complex workers' compensation claims to ensure timely and accurate resolution.
• Determine claim exposure and develop strategic action plans for resolution.
• Approve and process claim payments, benefits, and reserves.
• Negotiate settlements within designated authority levels.
• Prepare and submit state filings in compliance with statutory requirements.
• Oversee and manage litigation to ensure cost-effective resolutions.
• Coordinate referrals for vendors, investigations, or legal counsel when necessary.
• Apply cost containment strategies to control claim costs and protect client interests.
• Handle subrogation, Second Injury Fund recoveries, and Social Security/Medicare offsets.
• Maintain professional communication with clients, claimants, and internal teams.
• Document claim files accurately and ensure proper coding.
• Collaborate with supervisors and escalate cases as needed.

Required Qualifications:

• Minimum 3 years of California workers' compensation claims experience (mandatory)
• CA SIP certification is preferred, but not required
• High School Diploma or GED required; Bachelor's degree preferred
• 5 years of overall claims management experience or equivalent combination of education/experience

Skills & Competencies:

• Strong knowledge of California workers' comp laws, principles, and regulations
• Proficient in Microsoft Office and claims systems
• Exceptional negotiation, analytical, and organizational skills
• Effective communication and interpersonal abilities
• Ability to work independently and in a team setting
• Strong time management and ability to prioritize tasks effectively

Work Environment:

• Remote position with optional hybrid work for candidates near San Diego or Roseville offices
• Flexible work hours with 37.5-hour work week
• Occasional travel may be required
• Must pass a credit security clearance background check

Benefits:

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 237696 when responding to this ad.

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Salary : $50