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Senior Claims Examiner
Company : Nautilus Insurance Company
Location : San Diego, CA, 92108
Job Type : Full Time / Part Time
Date Posted : 9 January 2026
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
The Senior Workers’ Compensation Examiner is responsible for the analysis and management of complex workers’ compensation claims. This position will review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims. The position will process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. The role acts in a fiduciary role on behalf of policyholders, negotiates claim settlements and manages subrogation. Senior Claims Examiner’s conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California. The Senior Workers’ Compensation Examiner is expected to function with a degree of competency. The use of sound judgment coupled with consistent results is expected.
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
- Bachelor’s degree preferred
- 5+ 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: $100,000 – $120,000 • 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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Frequently asked questions
San Diego’s unique labor market and local regulations impact claims handling, requiring Senior Claims Examiners to navigate distinct workers’ compensation statutes. The city’s moderate claims volume compared to larger metros offers a balanced workload but demands familiarity with regional insurance trends and insurer partnerships.
In San Diego, professional certifications like the Workers’ Compensation Claims Professional (WCCP) credential are highly valued by insurers, including Nautilus Insurance Company. These certifications demonstrate mastery of California’s complex workers’ compensation laws and often improve career advancement prospects locally.
Successful Claims Examiners rely on advanced analytical abilities to assess claim exposures accurately, strong negotiation tactics to resolve settlements efficiently, and excellent communication to liaise with stakeholders. Mastery of claims software and legislative nuances is also essential for precision and compliance.
With experience, Senior Claims Examiners often progress into roles such as Claims Manager, Compliance Auditor, or Litigation Specialist. These positions leverage their deep understanding of claims complexities, leadership in decision-making, and strategic claims resolution skills to influence broader organizational processes.
While both roles handle claims, Senior Claims Examiners focus more on claim evaluation, compliance, and reserve management, often overseeing complex workers’ compensation cases. Senior Claims Adjusters tend to concentrate on investigation and settlement negotiations, sometimes across a wider range of insurance types.
Nautilus Insurance emphasizes candidates who demonstrate fiduciary responsibility, sound judgment in claims decisions, and the ability to manage litigation proactively. They value professionals committed to ethical claims handling and skilled in fostering positive relationships with policyholders and vendors.
At Nautilus, there’s a strong focus on specialized workers’ compensation claims within California, with an emphasis on compliance with WCAB rules and close coordination with distribution partners. This contrasts with broader claims roles elsewhere, making expertise in local legislation and client segments vital.
Senior Claims Examiners in San Diego typically earn between $100,000 and $120,000 annually, reflecting the region’s cost of living and industry standards. Nautilus Insurance Company’s compensation aligns with this market rate, complemented by comprehensive benefits including 401(k) and profit-sharing.
San Diego’s insurance market sees steady demand for skilled claims examiners, driven by its robust workers’ compensation sector. While competition exists due to the specialized nature of the role, candidates with certifications like WCCP and several years’ experience have a clear advantage.
Navigating California’s intricate workers’ compensation statutes and managing litigation timelines demand precision and persistence. Senior Claims Examiners must balance timely claim resolution with regulatory compliance while negotiating settlements within authority limits, all requiring strategic planning and thorough case analysis.