Rose International
Claims Examiner - Workers Compensation
Rose International, Orange, California, United States, 92613
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Claims Examiner - Workers Compensation
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Rose International Date Posted: 10/15/2025 Hiring Organization: Rose International Position Number: 490066 Industry: Software Job Title: Claims Examiner - Workers Compensation Job Location: Orange, CA, USA, 92868 Work Model: Hybrid (2 days in office per week) Shift: 08:00 AM – 05:00 PM Employment Type: Temporary (Full‑Time) Estimated Duration: 3 months Hourly Rate: $45.00 – $47.00 Must Have Skills/Attributes: Analytical Skills, Computer Literacy, Interpersonal Skills, Microsoft Office Experience Desired: CA Workers Compensation claims (3 yrs) Required Minimum Education: High School Diploma or equivalent Preferred Education: Bachelor’s Degree Job Description
To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high-exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Required Education
High School Diploma or equivalent Preferred Education
Bachelor's Degree from an accredited college or university Required Experience, Knowledge & Skills
Minimum three years of experience with CA Worker Compensation claims Five years of claims management experience or an equivalent combination of education and experience is required Subject matter expert of appropriate insurance principles and laws for the line-of-business handled, recoveries, offsets and deductions, claim and disability duration, cost containment principles including medical management practices, and Social Security and Medicare application procedures as applicable to the line-of-business Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Required Soft Skills
Analytical and interpretive skills Strong organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations Job Duties
Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well‑developed action plans to an appropriate and timely resolution Negotiates the settlement of claims within the designated authority Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within the designated authority level Prepares necessary state filings within statutory limits Manages the litigation process to ensure 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 the overall cost of claims for our clients Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets Reports claims to the excess carrier; responds to requests for directions in a professional and timely manner Communicates claim activity and processing with the claimant and the client; maintains professional client relationships Ensures claim files are properly documented, and claims coding is correct Refers cases as appropriate to the supervisor and management Performs other duties as assigned Supports the organization’s quality program(s) Travels as required Only those lawfully authorized to work in the designated country associated with the position will be considered. Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements. Benefits
For information and details on employment benefits offered with this position, please visit here. Legal
Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances. If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department. Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E‑Verify). (Posting required by OCGA 13/10‑91.).
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Claims Examiner - Workers Compensation
role at
Rose International Date Posted: 10/15/2025 Hiring Organization: Rose International Position Number: 490066 Industry: Software Job Title: Claims Examiner - Workers Compensation Job Location: Orange, CA, USA, 92868 Work Model: Hybrid (2 days in office per week) Shift: 08:00 AM – 05:00 PM Employment Type: Temporary (Full‑Time) Estimated Duration: 3 months Hourly Rate: $45.00 – $47.00 Must Have Skills/Attributes: Analytical Skills, Computer Literacy, Interpersonal Skills, Microsoft Office Experience Desired: CA Workers Compensation claims (3 yrs) Required Minimum Education: High School Diploma or equivalent Preferred Education: Bachelor’s Degree Job Description
To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high-exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Required Education
High School Diploma or equivalent Preferred Education
Bachelor's Degree from an accredited college or university Required Experience, Knowledge & Skills
Minimum three years of experience with CA Worker Compensation claims Five years of claims management experience or an equivalent combination of education and experience is required Subject matter expert of appropriate insurance principles and laws for the line-of-business handled, recoveries, offsets and deductions, claim and disability duration, cost containment principles including medical management practices, and Social Security and Medicare application procedures as applicable to the line-of-business Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Required Soft Skills
Analytical and interpretive skills Strong organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations Job Duties
Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well‑developed action plans to an appropriate and timely resolution Negotiates the settlement of claims within the designated authority Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within the designated authority level Prepares necessary state filings within statutory limits Manages the litigation process to ensure 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 the overall cost of claims for our clients Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets Reports claims to the excess carrier; responds to requests for directions in a professional and timely manner Communicates claim activity and processing with the claimant and the client; maintains professional client relationships Ensures claim files are properly documented, and claims coding is correct Refers cases as appropriate to the supervisor and management Performs other duties as assigned Supports the organization’s quality program(s) Travels as required Only those lawfully authorized to work in the designated country associated with the position will be considered. Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements. Benefits
For information and details on employment benefits offered with this position, please visit here. Legal
Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances. If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department. Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E‑Verify). (Posting required by OCGA 13/10‑91.).
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