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We are currently seeking an experienced Workers Compensation Lost Time Senior Claim Examiner to join our team in the Los Angeles, CA area. As a Workers Compensation Lost Time Senior Claim Examiner, you will handle a caseload of lost time workers compensation claims originating primarily from California. This Workers Compensation Lost Time Senior Claim Examiner role is an on-site position located in Los Angeles and focuses on delivering high-quality claims service in a fast-paced, customer-driven environment.
Job Responsibility:
Manage all aspects of lost time workers compensation claims from initiation through closure
Conduct three-part investigations, including statements from insureds, claimants, and medical providers
Determine claim compensability based on investigation outcomes
Administer statutory medical and indemnity benefits timely and accurately
Communicate denials and updates to insureds, claimants, attorneys, and involved parties
Set and adjust reserves within authority, escalating when necessary
Collaborate with legal counsel on hearings and litigation matters
Direct vendors and medical case managers on return-to-work strategies
Comply with all state and regulatory reporting requirements
Refer appropriate claims for subrogation and maximize recovery efforts
Partner with internal teams (nurses, investigators, case managers) for optimal claim outcomes
Prepare clear, professional documentation and reports
Requirements:
Prior experience handling workers compensation lost time claims required
Certification to manage California Workers Compensation claims required
Experience handling claims in CO, UT, NV, and AZ is a plus
Strong communication and analytical skills
Proficient in Microsoft Office and electronic claim systems
Familiarity with medical terminology and bill processing
Proven organizational and time management skills
Ability to manage multiple priorities and meet deadlines consistently
Commitment to high-quality work and service standards
Must obtain or maintain applicable state adjuster licenses as required
Nice to have:
Experience in fast-paced, customer-oriented environments
Background in insurance, legal, or corporate business environments
AIC, RMA, or CPCU coursework/designations (preferred but not required)
What we offer:
medical, vision, dental, and life and disability insurance