Sr Claim Examiner-WC (CA)
* Candidates must have extensive experience managing California Workers Compensation Claims!
* SIP is a requirement.
* Great Bonus Opportunities.
* Excellent Crawford Benefits.
* Multiple Employee Discounts.
Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision.
Works within established authority on moderate-to-difficult claims.
Reviews coverages, determines liability and compensability, secures information, arranges property damage appraisals and settles claims utilizing claims best practices.
Evaluates and sets reserves using independent judgment.
Assists supervisor and defense attorneys in preparing cases for litigations.
Conducts training and mentors new hires.
* Bachelor's degree or equivalent experience required.
* Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization.
* Ability to work independently while assimilating various technical subjects..
* Strong written and oral communication, negotiation and presentation skills.
* Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects.
* Effective advanced interpersonal skills to effectively interact with all levels of internal and external clients.
* Industry Designations: Preferred: IIA, AIC, AEI, and/or CPCU.
* License Requirements:Per State or Jurisdictional requirements.
* Workers Compensation (WC) Adjuster License required according to jurisdictional requirements
#LIEM3
* Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.
* Manages all aspects of investigative activity on complex claims.
Directs the discovery and litigation strategy with legal counsel.
* Analyzes claims activity and prepares reports for clients/carriers and management.
* Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.
* Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits.
* Develops subrogation and third party recovery potential and follows reclaim procedures.
* Analyzes claims activities and prepares reports for clients, carriers and/or management.
Participates in claim reviews.
- Rate: Not Specified
- Location: Brea, US-CA
- Type: Permanent
- Industry: Finance
- Recruiter: Crawford & Company
- Contact: Not Specified
- Email: to view click here
- Reference: 2295
- Posted: 2025-06-26 08:39:16 -
- View all Jobs from Crawford & Company
More Jobs from Crawford & Company
- Admin Assistant Sr Associate, Network & Clinical Operations - Evernorth Behavioral Health - Onsite
- Warehouse Associate- CuraScript SD- Onsite
- Business Project Advisor - Hybrid - Express Scripts
- Licensed Practical Nurse - Bilingual - Evernorth - Dalton GA
- Pharmacy Go To Market RFI Process Lead
- Financial Audit Analyst (Client Audit) - EVERNORTH
- Sr. Client Experience Manager - EviCore
- Business Analytics Advisor - National Contracts
- Business Product Owner - Senior Advisor - Express Scripts - Hybrid
- Pharmacy Packaging and Shipping Associate- Accredo
- New Business Manager; U500 (Hybrid; Clayton, MO)
- Data Management & Reporting Advisor - Cigna Healthcare - Remote
- Dental Sales Executive; U500(Overland Park, KS) - Hybrid
- Pharmacy Account Executive - Evernorth - Remote (Florida)
- Home Infusion Nurse - Accredo - Midland, TX
- Senior Product Manager / Product Manager
- Benefit & Well-being Educator, Midwest Region (Chicago)
- Home Infusion Nurse, Per Diem - Accredo - Harrisonburg, VA
- Home Infusion Nurse - Accredo - Pittsburgh, PA
- Business Analytics Lead Analyst (North Texas Provider Network) - Hybrid