Claims Examiner - Workers Compensation

BCForward is currently looking for Claims Examiner - Workers Compensation in Roseville, CA (Remote or Onsite)

Job Title: Claims Examiner - Workers Compensation
Location: Roseville, CA (Remote or Onsite)
Expected Duration: 5 months, Contract-to-Hire
Target Start date: 7/14/2025

Pay rate: $50.00/hr on W2

Job Summary

We are seeking an experienced Workers' Compensation Claims Examiner to analyze and manage complex or high-exposure WC claims. The ideal candidate will be responsible for determining benefits, handling litigation and rehabilitation cases, and ensuring the resolution of claims is in line with company standards, legal requirements, and client expectations.

Key Responsibilities

• Analyze and manage complex or technically difficult WC claims to determine benefits due.
• Develop and execute action plans for timely and effective claim resolution.
• Negotiate claim settlements within authority limits.
• Accurately calculate and assign reserves; manage reserve adequacy throughout the claim lifecycle.
• Process timely benefit payments, adjustments, and settlements.
• Prepare and submit required state filings within statutory deadlines.
• Coordinate and manage litigation strategy and vendor involvement.
• Implement cost-containment strategies through effective vendor use and claim management techniques.
• Pursue and manage recoveries, including subrogation and Medicare/SS benefits offsets.
• Communicate claim activity with claimants and clients, maintaining a professional relationship.
• Maintain proper claim documentation and ensure accurate coding.
• Escalate complex cases to supervisors when necessary.
• Support internal quality programs and participate in training as needed.
• Occasional travel may be required.

Qualifications

Education & Licensing:

• High school diploma or GED required; Bachelor's degree preferred.
• SIP certification preferred.

Experience:

• Minimum of 5 years of experience in workers' compensation claims management.

Skills & Knowledge:

• Expert understanding of WC laws, medical and disability guidelines, subrogation, and recovery procedures.
• Proficiency in Microsoft Office (Word, Excel, Outlook).
• Strong negotiation, communication (written and verbal), and interpersonal skills.
• Ability to analyze information, solve problems, and work independently or as part of a team.
• Excellent organizational skills and attention to detail.
• Ability to manage multiple priorities and meet deadlines.

Work Environment Requirements

• Mental: Ability to handle stress, multitask, and exercise discretion and judgment.
• Physical: Regular use of computer; ability to travel when required.
• Auditory/Visual: Clear hearing, vision, and verbal communication.

Note: A credit background check will be conducted for this role.

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 240112 when responding to this ad.