Certified WC Claims Examiner

Job Summary

We are seeking a Certified WC Claims Examiner for a contract opportunity in Martinez, CA. This role is a strong fit for an experienced workers compensation claims professional with hands-on indemnity claims experience, strong California workers compensation knowledge, and the ability to manage claims from intake through final resolution.

This opportunity offers a structured, professional claims environment where accuracy, compliance, timely benefit delivery, and thoughtful case analysis are highly valued. The Certified Workers Compensation Claims Examiner will work closely with claims teams, legal counsel, medical providers, supervisors, and internal stakeholders to evaluate claims, support sound decisions, and help ensure injured workers receive appropriate benefits.

The environment is well-suited for someone who enjoys detailed documentation, regulatory compliance, collaborative problem-solving, and working with supportive professionals who value clear communication, teamwork, and consistent claims practices.

Key Responsibilities

- Investigate, evaluate, and adjust workers compensation claims, including compensability, reserves, benefits, disability payments, and medical bills.
- Review medical records, legal documentation, claim history, evidence, and related information to support claim determinations and resolution strategies.
- Conduct interviews with claimants, witnesses, physicians, supervisors, and other involved parties.
- Document all claim activity accurately in electronic workers compensation claims management systems.
- Prepare reports, correspondence, case files, claim updates, and documentation for internal and external stakeholders.
- Support litigation activity, coordinate with legal counsel, negotiate settlements when appropriate, and ensure compliance with applicable regulations.

Compensation and Benefits

- Job type: Contract/Temporary.
- Location: Martinez, CA.

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.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.

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. Additional Skills

Required Qualifications and Skills

- Manage workers compensation indemnity claims from intake through final resolution.
- Apply California workers compensation laws, legal procedures, and regulatory requirements to claim decisions.
- Evaluate medical and legal documentation to determine compensability, benefit eligibility, reserves, and claim strategy.
- Maintain accurate electronic claim records, reports, payments, reserves, and correspondence.

- California Certified Claims Adjuster certification under Title 10 CCR 2592 or a Self-Insurance Certificate is required.
- 2+ years of workers compensation claims examiner experience is required, with 3+ years required for senior-level consideration.
- Hands-on experience handling workers compensation indemnity claims is required.
- 2 to 3+ years of experience using workers compensation claims management software is required.
- 2 to 3+ years of experience applying California workers compensation laws and regulations is required.
- Minimum of 60 college units or equivalent experience is required.
- Strong understanding of medical terminology, legal terminology, claims documentation, and reporting requirements.
- Ability to analyze claims, legal evidence, medical reports, disability benefits, medical bills, and settlement options.
- Strong communication, interviewing, negotiation, decision-making, and time management skills.
- Ability to manage multiple claims, competing deadlines, and detailed compliance requirements.

Preferred Qualifications

- Bachelors degree preferred.
- Senior-level candidates may provide leadership or guidance to claims staff.
- Experience supporting litigation processes, Medicare Set-Asides, ADA compliance, and settlement negotiations is preferred.