Claims Examiner - Workers Compensation

BCForward is currently looking for Claims Examiner - Workers Compensation (100% Remote)

Job Title: Claims Examiner - Workers Compensation

Location: Remote
Expected Duration: 03+ months (Contract or Direct Hire)
Pay rate: $50.00/hr on W2

Experience Needed: Minimum 3 years handling California Workers' Compensation claims, SIP Certification Required

Position Summary:

We are seeking an experienced Workers' Compensation Claims Examiner with a strong background in California WC claims. This fully remote role requires an active SIP certification and a minimum of 3 years of direct experience handling California jurisdiction claims. Public entity experience is a strong plus.

Primary Purpose:

To analyze, manage, and resolve complex and high-exposure workers' compensation claims in California. The examiner will ensure compliance with regulatory requirements, manage litigation, identify subrogation opportunities, and negotiate settlements in line with client expectations and industry best practices.

Key Responsibilities:

• Investigate and process complex workers' compensation claims, determining exposure and benefits due
• Develop and execute resolution strategies using detailed action plans
• Set, monitor, and update reserves appropriately throughout the claim lifecycle
• Calculate, authorize, and issue timely benefit payments and settlements within authority level
• File all necessary state-required documents in compliance with California WC regulations
• Handle litigated claims, coordinate with defense counsel, and participate in hearings as needed
• Refer cases for further investigation or litigation support when necessary
• Implement cost containment strategies, including working with medical management vendors
• Identify and pursue subrogation and recovery opportunities (e.g., Second Injury Fund, Medicare offsets)
• Communicate professionally with claimants, clients, attorneys, and internal teams
• Maintain accurate documentation and ensure coding compliance on claim files
• Escalate complex or high-risk matters to management as required

Qualifications:

Education:

• Bachelor's degree preferred
• Relevant industry certifications preferred (e.g., AIC, CPCU)

Experience:

• Minimum 3 years of California workers' compensation claims experience
• Experience with public entities a plus
• Total of 5+ years claims experience or equivalent education/experience mix preferred

Required Certification:

• SIP Certification (Self-Insurance Administrator Certificate) - Mandatory

Skills and Competencies:

• Deep understanding of California WC laws, regulations, and litigation procedures
• Exceptional negotiation, decision-making, and analytical skills
• Strong verbal and written communication; professional client interaction
• Proficiency in Microsoft Office and claims management systems
• Ability to multitask in a fast-paced, deadline-driven remote work environment
• Collaborative mindset with high attention to detail and compliance

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.

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.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 240232 when responding to this ad.