Top 5 Senior claims examiner Jobs in Pleasant Hill Ca

Claims Examiner/Senior Claims Examiner
Berkley —Walnut Creek, CA
- $65,000 - $115,000 a year
- Full-time
- Computer literacy
- Analysis skills
- Organizational skills
- Profit sharing
- Health insurance
Claims Supervisor
Athens Administrators —Concord, CA
- $119,000 - $132,000 a year
- Urgently hiring
- Bachelor of Science
- Employment & labor law
- Mid-level
- Health savings account
- AD&D insurance
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Senior Claims Examiner (Contribution)
ICW Group —Pleasanton, CA
- $68,481.25 - $115,489.01 a year
- Full-time
- Hybrid work
- OSHA
- Office
- Bachelor's degree
- Paid holidays
- Health insurance
Workers' Compensation Senior Claims Examiner, Complex & Settlement Focus
ICW Group —Pleasanton, CA
- $68,481.25 - $115,489.01 a year
- Full-time
- Hybrid work
- 5 years
- Office
- Bachelor's degree
- Paid holidays
- Health insurance

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Manager of Vendor Oversight
Partnership HealthPlan of California —Fairfield, CA
Or state audits related to vendor performance. Supports Compliance and Regulatory teams to prepare for CMS and state readiness. Both verbally and in writing.
$122,667.11 - $159,467.24 a year
Claims Supervisor
Athens Administrators —Concord, CA
Valid driver’s license and ability to travel, including in-office file reviews and meetings. Manage existing client relationships by being accessible, making…
$119,000 - $132,000 a year
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Auto Claims Examiner
Atlantic Casualty Insurance Company —Columbus, OH
A valid resident adjuster license for the license state of the applicant. A non-resident adjuster’s license where required in the states where we do business.
$84,520.80 - $112,039.20 a year
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Workforce Absence Team Lead Sr
Sedgwick —Dublin, OH
PRIMARY PURPOSE : To supervise the operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues'…

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Claims Examiner/Senior Claims Examiner

Berkley -
Walnut Creek, CA

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Job Details

Full-time
$65,000 - $115,000 a year

Benefits

Profit sharing
Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance

Qualifications

Claims negotiation
Workers' compensation insurance knowledge

Full Job Description

Company Details:

Preferred Employers Insurance, A Berkley Company specializes in providing workers’ compensation insurance to California business owners. The company serves three major Product/Client Segments: Small Business, Mid-Larger Businesses and Group Association Members (Programs). The company’s distribution partners (agents & brokers) number just under 400 locations throughout the state. Preferred serves thousands of policyholders and provides medical claims handling and claims management as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company.

Company URL: https://www.peiwc.com

The company is an equal opportunity employer.

Responsibilities:

We are seeking Workers’ Compensation Claims Examiners and Senior Claims Examiners to join our team. In these roles, you will be responsible for the analysis and management of moderate to complex workers’ compensation claims, including reviewing, investigating, and making determinations around coverage, compensability, and claim appropriateness. You will ensure all claims are processed and documented in compliance with company standards, industry best practices, and applicable legislative requirements while acting in a fiduciary capacity on behalf of policyholders.

Our Claims Examiners are expected to handle claims with the utmost good faith, fully aligned with the rules, regulations, and statutes of the Workers' Compensation Appeals Board (WCAB) and the State of California. Success in this role requires strong judgment, consistent performance, and a high level of competency in negotiating settlements, managing subrogation, and delivering sound, compliant outcomes.

Key functions include but are not limited to:

Analyzes and processes workers’ compensation claims by investigating and gathering information to determine the exposure on the claim.
Negotiates settlement of claims up to designated authority level and makes claims payments.
Processes complex or technically difficult claims.
Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim.
Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level.
Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
Prepares necessary state filings within statutory limits.
Actively manages the litigation process; ensures timely and cost-effective claims resolution.
Coordinates vendor referrals for additional investigation and/or litigation management.
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner.
Frequently communicates with all appropriate parties involved with the claim.
Refers cases as appropriate to management.
Maintains professional client relationships.
Actively executes appropriate claims activities to ensure consistent delivery of quality claims service.

Qualifications:

2+ years claims management experience.
Professional certification as applicable to workers’ compensation required
WCCP Preferred
In depth knowledge of appropriate insurance principles and laws for workers’ compensation.
Strong written and verbal communication skills.
Strong organizational skills.
Strong negotiation skills
Strong analytical and interpretive skills.
PC literate.
Professional certification as applicable to workers’ compensation required.

Additional Company Details: We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $65,000 – $115,000 annually • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details: Sponsorship not Offered for this Role

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senior claims examiner jobs in pleasant hill ca

Claims Examiner/Senior Claims Examiner

Claims Supervisor

Senior Claims Examiner (Contribution)

Workers' Compensation Senior Claims Examiner, Complex & Settlement Focus

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