Workers Compensation Senior Claim Representative

Workers Compensation Lost Time Sr Claim Examiner

Currently seeking a Workers Compensation Lost Time Sr Claim Examiner for our West Coast / Pacific region. The successful applicant will be handling claims from California. The position will report and reside in our Los Angeles, CA.

Duties and Responsibilities :

• Handles all aspects of workers compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
• Reviews claim and policy information to provide background for investigation.
• Conducts 3-part ongoing investigations obtaining facts and taking statements as necessary with insured claimant and medical providers.
• Evaluates the facts gathered through the investigation to determine compensability of the claim.
• Informs insureds claimants and attorneys of claim denials when applicable.
• Prepares reports on investigation settlements, denials of claims, and evaluations of involved parties, etc.
• Timely administration of statutory medical and indemnity benefits throughout the life of the claim.
• Sets reserves within authority limits for medical indemnity and expenses and recommends reserve changes to Team Leader throughout the life of the claim.
• Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
• Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.
• Works with attorneys to manage hearings and litigation.
• Controls and directs vendors, nurse case managers, telephonic case managers, and rehabilitation managers on medical management and return to work initiatives.
• Complies with customer service requests including Special Claims Handling procedures, file status notes, and claim reviews.
• Files workers compensation forms and electronic data with states to ensure compliance with statutory regulations.
• Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.
• Works with in-house Technical Assistants, Special Investigators, Nurse Consultants, Telephonic Case Managers, as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.

Technical Skills Competencies :

Experience Education Requirements :

Job Type & Location :

This is a Contract to Hire position based out of Los Angeles, CA.

Pay and Benefits :

The pay range for this position is $46.00 - $48.00 / hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following :

Workplace Type :

This is a fully onsite position in Los Angeles, CA.

Application Deadline :

This position is anticipated to close on Dec 3, 2025.

About TEKsystems :

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe, and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.