Job ID: 1802714
Reference Code: KD-Claims-Examiner,Workers Comp Remote
Job Summary:
To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements
Must have a Minimum 3years of relevant CA WC claims experience is mandatory.
California WC Claims handling experience
Must have OSIP certificate
Remote but within California
Education & Licensing; Bachelor's degree from an accredited college or university preferred
Equal Opportunity Employer / Disabled / Protected Veterans
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For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
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We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Required Qualifications and Skills
- Analyze and manage complex workers’ compensation claims.
- Handle high exposure claims involving litigation and rehabilitation.
- Identify subrogation opportunities and negotiate settlements.
- Ensure ongoing claim adjudication aligns with service expectations and client requirements.
- 3 to 5 years of workers’ compensation claims experience.
- Strong knowledge of workers’ compensation claims review, adjusting, and benefit determination.
- Experience managing technically difficult or litigated claims.
- Ability to evaluate claim exposure, document claim activity, and support effective resolution strategies.
- Strong negotiation, analytical, organization, and communication skills.
- Ability to work within established service standards, best practices, and client-specific guidelines.
Preferred Qualifications
- Experience handling California workers’ compensation claims.
- Experience with high exposure, litigated, or complex claims.
- Background in subrogation identification and settlement negotiation.
- Strong familiarity with insurance claims systems and documentation standards.