Claims Examiner - Workers Compensation (1482743)

Job Title: Claims Examiner - Workers Compensation (1482743)

Location: Ontario, California, 91764-4922
Duration: Contract - 3 months
Pay Range: $45/hr $49.07/hr (W2)
Job ID: 372133

About BCforward

BCforward is a leading global IT consulting and workforce solutions firm providing services and support to Fortune 500 and government clients. Founded in 1998, BCforward has grown with our customers needs into a full-service business solutions provider. With delivery centers and offices across North America and India, we take pride in building long-term relationships and delivering excellence through innovation, collaboration, and integrity.

Job Description

We are seeking a Claims Examiner - Workers Compensation to join our team. The ideal candidate will have strong experience in California workers' compensation, lost time claims, and litigation management and a proven ability to adjudicate complex claims, control costs, and drive timely, compliant resolutions.

Responsibilities:

• Analyze and process complex or technically difficult workers' compensation claims, including lost time claims, from investigation through resolution.
• Develop and execute action plans to achieve appropriate and timely claim outcomes.
• Negotiate settlements within designated authority and document rationales.
• Establish, monitor, and adjust reserves to maintain adequacy throughout the claim life cycle.
• Calculate and issue benefits, approve payments and adjustments, and ensure accurate coding and documentation.
• Prepare and submit required state filings within statutory timeframes.
• Manage litigation strategy and collaborate with defense counsel for cost-effective resolutions.
• Coordinate vendor referrals for investigations, medical reviews, and litigation support.
• Apply cost containment techniques, including medical management and strategic vendor partnerships.
• Pursue recoveries including subrogation, Second Injury Fund, and applicable Social Security and Medicare offsets.
• Report to excess carriers and respond to directives in a timely and professional manner.
• Communicate claim status and strategy with claimants, clients, and stakeholders to maintain strong relationships.
• Refer cases to supervisors or management as appropriate and support organizational quality programs.

Required Skills & Qualifications:

• 3+ years of recent and relevant workers' compensation claims experience, including lost time claims.
• SIP certification in California is mandatory.
• Subject matter knowledge of workers' compensation principles, applicable laws, recoveries, offsets, and cost containment practices.
• Experience managing high exposure claims, litigation, state filings, and settlement negotiations.
• Proficiency with Microsoft Office and claim systems; strong analytical and interpretive skills.
• Clear written and verbal communication, organization, teamwork, and negotiation abilities.

Preferred Skills:

• Bachelor's degree and/or relevant professional certification.
• Five or more years of claims management experience or equivalent education and experience mix.

Work Environment & Additional Information:

• Onsite or hybrid if within 25 miles of a Sedgwick office. Remote within California otherwise. Travel as required.
• Mental demands include sound judgment, problem solving, prioritization, and deadline management.
• Physical demands include computer keyboarding and standard office tasks. Auditory/visual demands include hearing, vision, and talking.
• Credit security clearance confirmed via background credit check is required.

Why BCforward?

At BCforward, we believe in advancing lives and careers. When you join our team, you gain access to:

• Competitive compensation and benefits.
• Opportunities for growth with global clients.
• A supportive, inclusive culture that values innovation and people.
• Exposure to cutting-edge technologies and projects.

About Our Commitment

BCforward is an equal opportunity employer. We value diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, or veteran status.

Interested? Apply Now!

If this sounds like the right opportunity for you, please apply with your most recent resume or contact:
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