Claims Examiner - Workers Compensation

BC Forward is Looking for Workers' Compensation Claims Examiner at Roseville, CA

Job Title: Workers' Compensation Claims Examiner - CA WC
Location: Roseville, CA 95678
Estimated Start Date :5/12/2025
Pay Rate: $50.00

Job Summary:

We are seeking an experienced Workers' Compensation Claims Examiner to join our team in Roseville, CA. This role is responsible for handling complex and technically challenging California Workers' Compensation claims, with a focus on public entity clients and indemnity claims. The successful candidate must have a strong working knowledge of CA WC regulations, possess the OSIP certification, and demonstrate expertise in litigation management and settlement negotiation.

Key Responsibilities:

• Analyze and manage high-exposure and complex California workers' compensation claims for public entity clients.
• Determine benefit eligibility, coordinate rehabilitation efforts, and resolve claims in compliance with state law and client service standards.
• Calculate and assign reserves; review and adjust reserves throughout the life of the claim.
• Pay benefits, approve payments, and settle claims within designated authority levels.
• Ensure timely and accurate preparation of all required state filings.
• Manage and coordinate litigation processes; work closely with defense counsel to achieve cost-effective resolutions.
• Identify and pursue subrogation opportunities and recoveries (e.g., Second Injury Fund, Medicare offsets).
• Collaborate with vendors for investigations, medical case management, and legal support.
• Maintain detailed claim documentation and ensure compliance with appropriate coding and audit requirements.
• Report to excess carriers and respond to inquiries in a timely, professional manner.
• Maintain strong relationships with claimants and clients; provide regular status updates.
• Support internal quality assurance and compliance initiatives.
• Travel occasionally, as needed.

Required Qualifications:

• Minimum 3 years of recent and relevant California Workers' Compensation claims handling experience.
• Proven experience managing indemnity claims for public entity clients.
• OSIP Certification is mandatory.
• High School Diploma or GED required; Bachelor's degree preferred.
• 5+ years of overall claims management experience or equivalent education and experience.
• In-depth knowledge of California Workers' Compensation laws and regulations.
• Strong negotiation, analytical, and organizational skills.
• Proficiency with Microsoft Office and claims management systems.
• Excellent verbal and written communication skills.

Preferred Skills:

• Experience with subrogation and recovery processes.
• Ability to manage multiple priorities in a fast-paced environment.
• Proven track record of working independently and as part of a team.
• Familiarity with cost-containment strategies and vendor management.

Work Environment Requirements:

• Ability to work under stress and meet deadlines.
• Standard office environment with occasional travel.
• Requires use of a computer, keyboarding, and communication equipment.

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.

Interested candidates please send resume in Word format Please reference job code 238265 when responding to this ad.