Job Description

Join Our Dynamic Team as a Workers' Comp Claims Oversight Specialist!

Position: Claims Oversight Specialist

Location: In-Office, Rancho Cordova, CA 95670

Job Type: Full-time Exempt

Salary: $71,000 – $95,000

Who We Are: EmployInsure LLC delivers Engineered Employment Products designed to eliminate gaps from antiquated practices and enable Frictionless Employment for customers across the employment value chain. Our Mission is to inspire and redefine the relationship between industry and individual by transparently connecting all buyers and sellers of talent to create maximum value .

Our diverse team is powered by forward-thinkers, innovators, and rapid problem-solvers. We are committed to making a significant impact to scale the company. We believe in fostering a collaborative and inclusive work environment where every voice is heard and valued.

EmployInsure is the parent company of its brands; Samuel Hale and Evoove, in exclusive partnership with the PACT. To learn more about us and our family of companies, check out our websites!

Our Core Values:

• Entrepreneurial Spirit: A mindset that involves seeking out change, taking risks, and pursuing new opportunities.
• Quest for a Deeper Understanding : A true professional never stops getting better at their craft. They practice and measure and debate over their understanding of the truth, embodying a growth mindset.
• The Stockdale Paradox: We confront the brutal honesty of our current reality while always maintaining an unwavering faith in our ability to overcome all challenges that get in our way. We have toughness, determination, and passionate belief!

Job Description:

We seek to hire an experienced Claims Oversight Specialist to join our claims oversight team. The ideal candidate will have experience in California worker's compensation, denying, settling, or authorizing payments to workers comp claims. In this role, you will be responsible for corresponding with policyholders, claimants, witnesses, attorneys, etc., to gather important information to support contested claims.

• Investigating claims and compiling reports within the given timeframe after receipt of the first injury report
• Preparing and delivering claims updates and reviews to internal stakeholders and clients
• Strategically handle investigations and tactically tackle issues
• Requesting records as required
• Notifying the employer of his or her claim determination based on findings
• Collecting and evaluating claims and authorizing payments
• Keeping contact with the injured worker and the medical professionals concerning the status of the injury and plans for treatment
• Contacting claimant’s employers or doctors for additional information if the claim is questionable
• Assessing settlement decisions and opportunities
• Being present at mediations, either by phone or in person
• Ensuring that injured workers are taken care of appropriately and on time

Basic Qualifications:

• 3+ years of direct workers' comp claims experience
• 1+ years of California workers' comp experience
• Good time management skills
• Adequate knowledge of relevant regulations
• Skilled customer service skills and attention to detail
• Demonstrated experience investigating workers' comp claims
• Excellent customer support
• Extensive claim review experience
• Prior claim settlement experience
• Insurance claims management software experience and technical proficiency

We Offer a Best-in-Class Professional Benefits Package to Support our Employees:

• Comprehensive premium Healthcare Coverage: Medical, dental, and vision plans: Employees 100% covered by company. Low deductibles for souse/partner and dependents
• Generous Paid Time Off: Unlimited paid time off policy and paid holidays
• Profit Sharing Plan: Share in the success of the company
• Retirement Savings Plans: 401(k) with 5% company match to help you secure your financial future
• Lifetime pension plan: Vest into our pension plan for a lifetime income
• Wellness Support: Access to wellness programs, mental health resources, financial counseling, legal support, and employee assistance programs.
• Professional Growth Opportunities: Learning resources to help you thrive.
• Death Benefits: Company-paid to protect you and your loved ones.
• Flexible Work Options: Hybrid or remote work arrangements (where applicable).
• Exclusive Perks: Employee discounts, commuter benefits, and more.

Join us and experience a benefits package designed to empower your well-being, career growth, and personal goals!

Samuel Hale is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

Samuel Hale is an E-Verify company. For more information, please review our Participation and Your Right to Work .

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