Claims Examiner III

? Claims Examiner III Workers Compensation

$80K$83K + Benefits

Hybrid Remote | Fresno, CA (2 days per week onsite)

This role is ideal for a strong claims professional who enjoys handling challenging files, working independently, and supporting operational excellence across multiple claim assignments and jurisdictions.

At the Direction of the Claims Supervisor, and/or Manager and under minimal supervision manages all aspects of litigated indemnity claims handling from inception to conclusion within established authority and guidelines.

This position requires considerable interaction with clients, claimants, medical providers, Attorneys, vendors, Nurse and Vocational Case Managers, and other company staff.

Essential Responsibilities:

• Manage complex, litigated, and non-disabling Workers Compensation claims from inception through resolution
• Conduct timely investigations and determine claim compensability based on state regulations and company guidelines
• Administer benefits and oversee medical treatment and billing management
• Coordinate with attorneys, medical providers, vendors, nurse case managers, and vocational specialists
• Manage proactive diary systems, claim documentation, and workflow organization
• Set and manage reserves within established authority levels
• Handle settlements, claim closures, and resolution strategies
• Identify opportunities for subrogation, apportionment, and excess reporting
• Assist with audits, reporting requirements, and compliance initiatives
• Mentor and support less experienced Claims Examiners
• Support floating or temporary caseloads based on operational needs

Qualifications:

• 5+ years of Workers Compensation claims experience
• Strong experience handling complex and litigated claims files
• Knowledge of workers compensation regulations and medical terminology
• Ability to independently manage claims and prioritize competing deadlines
• Strong analytical, organizational, and communication skills
• Experience working with attorneys, vendors, and medical providers
• Proficiency with Microsoft Word and Excel preferred
• California Self-Insurance Certificate or applicable jurisdictional certification preferred

Why This Opportunity

• Hybrid flexibility with work-from-home opportunities
• High-impact role supporting complex claims operations
• Collaborative team environment with leadership support
• Opportunity to mentor junior claims professionals
• Stable organization with strong long-term growth potential

Compensation & Benefits

• $80K$83K compensation package
• Medical, dental, and vision insurance
• Life and disability insurance
• 401(k) plan with match
• 11 Paid holidays + 2 Floating Holidays
• ?PTO (16 days + additional PTO for volunteering and more)
• Dependent Scholarship Program
• President's Award ($1500)
• HSA
• Fitness Club Membership Allowance
• Hybrid remote flexibility

If youre an experienced Workers Compensation professional looking for a dynamic claims environment with flexibility and career stability, wed love to connect.