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Workers' Compensation Examiner

Workers' Compensation Examiner

InsuranceJobs.comWindsor, California, United States
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Annual Salaries :

$94,326 - $120,388 (DOE) – Senior Claims Examiner

$78,608 - $100,325 (DOE) – Claims Examiner

Qualifications :     Please see attached job descriptions

Terms :                  Full Time

12 Month Position

Subject to one-year probationary period

Benefits :

MANDATORY PARTICIPATION FOR MEDICAL BENEFITS.

Employee / dependent medical (80% Employer / 20% Employee);

employer paid dental, vision, life insurance, short term / long term

disability; employee / employer paid retirement (CalPERS);

vacation and sick leave.

RESIG does not pay into Social Security or SDI—State Disability.

Submission Deadline :     October 17, 2025 at 4 : 30pm PST

Application Materials :     Please refer to www.resig.org

Candidates must deliver by email to apply@resig.org :

  • Cover letter
  • Completed application
  • Resume of experience
  • 3 letters of recommendation

Examination Process :

The examination of each position will consist of :

1. Evaluation of the application material submitted. Incomplete submission packets will be rejected.

2. Qualified applicants will be asked to attend an interview October 22, 2025 and, if needed, for a second interview October 27, 2025 .  It is preferred that these interviews are in-person.

3. All applicants will also be asked to successfully complete a Basic Skills Test.

WORKERS’ COMPENSATION SENIOR CLAIMS EXAMINER

(EXEMPT POSITION)

Definition

This is an advanced Claims Examiner position. Under the general supervision of the Workers’ Compensation Manager and Claims Supervisor, this position is responsible for the investigation, evaluation, and settlement of claims.

Principle Job Duties

  • In accordance with claims management procedures, review, investigate, and manage workers’ compensation claims for member school districts with        use of a computerized claims management system.
  • Obtain all documentation to substantiate the facts surrounding a claim.
  • Evaluate and analyze the extent of exposure to accurately reserve claims.
  • Analyze, make recommendations, and approve medical treatment plans from treating physicians and providers.
  • Administer claim settlement authority according to policy.
  • Administer statutory benefits to injured workers.
  • Identify and pursue potential subrogation.
  • Identify excess insurance claims, prepare reports to excess insurance carriers, and process reimbursements.
  • Prepare concise reports for attorneys, physicians, member districts, and management.
  • Provide status update to management on complex and / or sensitive claims.
  • Develop and conduct periodic file reviews with member districts.
  • Prepare claims for defense, settlement, subrogation, or arbitration activity.
  • Provide direction to defense counsel, investigators, and vendors. Monitor and control claims costs.
  • Delegate non-essential and / or clerical work to Claims Assistants and clerical support staff.
  • Develop and implement strategy to manage claims to an accurate and timely conclusion.
  • Provide backup to Claims Examiners in their absence.
  • WORKERS’ COMPENSATION CLAIMS EXAMINER

    (NON-EXEMPT POSITION)

    Definition

    Under direct supervision of the Workers’ Compensation Manager, this position is responsible for the investigation and evaluation of claims assigned. Assignments will be made using the following criteria and at the discretion of the Workers’ Compensation Manager.

  • Medical only claims exceeding 1 or 2 medical visits.
  • Future medical claims deemed appropriate by the Workers’ Compensation Manager.
  • Any loss deemed appropriate pursuant to the discretion of the Workers’ Compensation Manager.
  • Principal Job Duties

  • In accordance with claims management procedures, reviews, investigates, and processes workers’ compensation claims for member school districts          with use of a computerized claims management system.
  • Obtain all documentation to substantiate the facts surrounding a claim – i.e., medical bills, medical reports, investigation reports.
  • Evaluate and analyze extent of claim to accurately reserve a file.
  • Identify and pursue subrogation potential.
  • Prepare concise reports, when required, to physicians.
  • Keep appropriate school districts personnel and management advised of file status as required.
  • Maintain close communication with management on work in progress and sensitive issues.
  • Determine need for and provide direction to investigators. Monitor and control their costs.
  • Perform related duties as assigned.
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    Examiner • Windsor, California, United States

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