claims examiner iii

TEEMA

<div>Job Summary
Workers Compensation Claims Examiner III
TeemaGroup
Full-time
In-Office | Kapolei, HI, United States 
POSITION SUMMARY
At the direction of the Claims Supervisor and/or Claims Manager, the Claims Examiner II / III manages all aspects of workers&rsquo; compensation indemnity, medical-only, future medical, and litigated claims from inception through resolution, within established authority and company/client guidelines.
This role requires frequent interaction with clients, claimants, medical providers, attorneys, vendors, nurse case managers, vocational case managers, and internal staff.
The level of complexity, litigation exposure, settlement authority, and leadership responsibility will be commensurate with the examiner&rsquo;s experience and designation (Level II or Level III).
DUTIES AND RESPONSIBILITIES
Core Responsibilities (Applies to Examiner II &amp; III)<ul><li>Manage a full caseload of workers&rsquo; compensation claims, including complex indemnity claims.</li><li>Initiate, conduct, and document timely and thorough claim investigations.</li><li>Determine compensability and administer benefits in accordance with state laws, rules, and company/client handling instructions.</li><li>Manage medical treatment and medical billing; authorize services as appropriate.</li><li>Communicate effectively with claimants, medical providers, vendors, and clients regarding claim issues.</li><li>Compute and set reserves in accordance with Company and Client guidelines.</li><li>Maintain an organized diary system and document claim files to reflect status, strategy, and action plans.</li><li>Settle and/or finalize claims and obtain appropriate settlement authority.</li><li>Conduct scheduled file reviews and respond to client inquiries.</li><li>Identify injury trends, safety concerns, and other claim-related issues and communicate proactively to clients.</li><li>Adhere to all TRISTAR company policies, procedures, and best practices.</li><li>Utilize office systems and technology efficiently to manage caseload responsibilities.</li><li>Perform other related duties as assigned.</li></ul>
Advanced / Senior Responsibilities (Primarily Examiner III)<ul><li>Manage very complex, catastrophic, and litigated indemnity claims from inception to conclusion.</li><li>Refer cases to outside defense counsel and actively participate in litigation strategy, hearings, mediations, and settlements.</li><li>Identify and manage:</li><li>Subrogation opportunities</li><li>Apportionment potential</li><li>Excess reporting criteria and reimbursement</li><li>Prepare and assist with state audits, regulatory reporting, and client-specific reporting requirements.</li><li>Develop and execute proactive claim strategies to drive timely and cost-effective resolution.</li><li>Conduct detailed client file reviews and participate in client meetings as needed.</li><li>Mentor and provide technical guidance to less experienced Claims Examiners.</li><li>Handle multi-jurisdictional workers&rsquo; compensation claims as assigned.</li></ul>
Essential job functions.
QUALIFICATIONS REQUIRED
Education &amp; Experience<ul><li>Claims Examiner II:</li><li>Bachelor&rsquo;s degree in a related field (preferred)</li><li>Minimum 3+ years of workers&rsquo; compensation claims experience, or equivalent combination of education and experience</li><li>Claims Examiner III:</li><li>Minimum 5+ years of progressive workers&rsquo; compensation claims experience</li><li>Demonstrated experience handling complex and litigated indemnity claims</li></ul>
#Workwolf</div>

Workers Compensation Claims Examiner III

<div>Job Summary
Workers Compensation Claims Examiner III
TeemaGroup
Full-time
Hybrid | Philadelphia, PA, United States 
 
The Opportunity
You&rsquo;re the kind of person who is always looking to learn. You want to grow into something greater and you&rsquo;re looking for an employer encourages and supports your professional development. This is the largest privately held Third party claims administrator in the US. 
Responsibilities<ul><li>
Adjuster will work hybrid</li><li>
Effectively manages a caseload of 125 to 150 workers&rsquo; compensation files, including very complex claims. *</li><li>
Jurisdiction is PA and NJ. *</li><li>
Initiates and conducts investigation in a timely manner. *</li><li>
Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines. *</li><li>
Manages medical treatment and medical billing, authorizing as appropriate. *</li><li>
Refers cases to outside defense counsel. Directs and manages as appropriate. *</li><li>
Communicates with claimants, providers and vendors regarding claims issues. *</li><li>
Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II. *</li><li>
Settles and/or finalize all claims and obtains authority as designated. *</li><li>
Maintains diary system for case review and documents file to reflect the status and work being performed on the file. *</li><li>
Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns. *</li><li>
Involves TRISTAR loss control staff when appropriate. *</li><li>
Adheres to all Company policies and procedures. *</li><li>
Conducts file reviews independently. *</li><li>
Other duties as assigned.</li></ul> 
Education/Experience: Bachelor&rsquo;s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience. 
 
Knowledge, Skills and Abilities:<ul><li>
Technical knowledge of statutory regulations and medical terminology.</li><li>
Analytical skills.</li><li>
Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.</li><li>
Ability to interact with persons at all levels in the business environment.</li><li>
Ability to independently and effectively manage very complex claims.</li><li>
Proficient in Word and Excel (preferred).</li></ul>
#Workwolf</div>

Cala Sourcing Solutions LLC

<div><h3 class="jobSectionHeader">Workers&rsquo; Compensation Claims Examiner III (Contract)</h3>
Please no 3rd party recruiters, or C2C.
Location: Irving, TX 
Schedule: On-site | Monday&ndash;Friday (5 days/week) - only local candidates will be considered 
Pay Rate: $36.53 &ndash; $38.46 per hour 
Contract Length: 3&ndash;4 months (with potential extension)<h4 class="jobSectionHeader">
About the Role</h4>
We&rsquo;re looking for a seasoned Workers&rsquo; Compensation Claims Examiner III to step into a fast-paced, high-volume environment and take ownership of Texas loss-time claims from start to finish. This role is ideal for an experienced examiner who is confident working independently, thrives in an in-office setting, and understands the importance of accuracy, urgency, and strong communication.
This is a fully on-site position in Irving, TX. Daily in-person collaboration with colleagues and stakeholders is a core part of the role&mdash;remote or hybrid work is not available.<h4 class="jobSectionHeader">
What You&rsquo;ll Be Doing</h4><ul><li>
Handle Texas Workers&rsquo; Compensation indemnity claims from initial intake through resolution</li><li>
Analyze coverage, investigate facts, and make compensability determinations in compliance with Texas statutes</li><li>
Administer indemnity and medical benefits within assigned authority levels</li><li>
Apply internal best practices and client-specific handling guidelines consistently</li><li>
Prepare and maintain detailed, captioned claim reports and documentation</li><li>
Serve as a key point of contact for claimants, employers, attorneys, and internal partners</li><li>
Clearly explain the claims process to employers and injured workers, setting expectations throughout the claim lifecycle</li><li>
Maintain accurate, timely claim files while balancing multiple deadlines</li><li>
Deliver a high level of customer service in a regulated, deadline-driven environment</li></ul><h4 class="jobSectionHeader">
What We&rsquo;re Looking For</h4><ul><li>
Active Texas Workers&rsquo; Compensation Adjuster License (required)</li><li>
5+ years of hands-on Texas Workers&rsquo; Compensation claims experience</li><li>
Prior experience handling public entity and First Responder claims</li><li>
Strong working knowledge of Texas Workers&rsquo; Compensation laws and regulations</li><li>
Excellent written and verbal communication skills</li><li>
Ability to manage a full caseload with minimal supervision</li><li>
High School Diploma or GED required</li><li>
Bachelor&rsquo;s degree in a related field preferred</li></ul><h4 class="jobSectionHeader">
Work Environment &amp; Expectations</h4><ul><li>
100% on-site role in a professional office setting</li><li>
Frequent interaction with internal teams and external stakeholders</li><li>
Use of standard office equipment and claims management systems</li><li>
Consistent, full-time in-office attendance required</li></ul><h4 class="jobSectionHeader">
Additional Requirements</h4><ul><li>
Ability to pass a background check and drug screening</li><li>
Authorization to work in the United States</li></ul>
#Workwolf</div>

Worker's comp/Claims examiner III

TRISTAR

<div><div><div>Please make sure to complete all the questions and navigate to the end of the application to sign it. This position is a hybrid, temp-to-hire opportunity, and SIP is required for this position.</div></div>
<div><div>POSITION SUMMARY: At the Direction of the Claims Supervisor and/or Manager, manages all aspects of complex and litigated indemnity claims from inception to conclusion within established authority and guidelines.
</div></div><div><div>This position requires considerable interaction with clients, claimants, Medical providers, Attorneys, vendors, Nurse and Vocational Case Managers and other TRISTAR staff.
</div></div><div><div>DUTIES AND RESPONSIBILITIES:</div></div><ul><li><div>
Effectively manages a caseload of indemnity claim files, including very complex and litigated claims.*</div></li><li><div>
Initiates and conducts investigation in a timely manner.*
</div></li><li><div>Determines compensability of claims and administer benefits based upon state law and TRISTAR Best Practices for claim handling.*</div></li><li><div>
Manages medical treatment and medical billing, authorizing as appropriate.*</div></li><li><div>
Refers cases to outside defense counsel and participates in litigated matters.*
</div></li><li><div>Communicates with claimants, attorneys, providers and vendors regarding claims issues.*</div></li><li><div>
Work in an organized and proactive manner.*</div></li><li><div>
Computes and set reserves within Company guidelines.*
</div></li><li><div>Settles and/or finalize all claims and obtains authority as designated.*</div></li><li><div>
Maintains diary system for case review and documents file to reflect the status and work being performed on the file, including a plan of action.*</div></li><li><div>
Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.*</div></li><li><div>
Conducts file reviews as scheduled by the client and management.*</div></li><li><div>
Identify and review claims for Apportionment assignment.*</div></li><li><div>
Identify and investigate subrogation potential and pursue recovery.*</div></li><li><div>
Identify claim standard criteria for excess reporting and reimbursement.*</div></li><li><div>
Assist with State Audit and reporting responses.*</div></li><li><div>
Mentors less experienced Examiners</div></li><li><div>
Other duties as assigned and including claims management of other jurisdictional workers&rsquo; comp claims.</div></li><li><div>
Adheres to all TRISTAR company policies and procedures.*</div></li></ul><div><ul><li>Essential job function.</li></ul></div>
<div><div>EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment.</div></div><div><div>
SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire</div></div>
QUALIFICATIONS REQUIRED:
Education/Experience: Minimum five (5) or more years related experience; or equivalent combination of education and experience.
Knowledge, Skills and Abilities:<ul><li>
Technical knowledge of statutory regulations and medical terminology.</li><li>
Analytical skills.</li><li>
Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.</li><li>
Ability to interact with persons at all levels in the business environment.</li><li>
Ability to independently and effectively manage very complex claims.</li><li>
Proficient in Word and Excel (preferred).</li></ul>
Other Qualifications:
Licenses as required by Jurisdiction..
Here are some of the benefits you can enjoy in this role:<ul><li>
Medical, Dental, Vision Insurance.</li><li>
Life and Disability Insurance.</li><li>
401(k) Plan
</li><li>Paid Holidays</li><li>
Paid Time Off.</li><li>
Referral bonus.</li></ul>
Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements]<div><div>
MENTAL AND PHYSICAL REQUIREMENTS</div><div><div> 
1. MENTAL EFFORT
a. Reasoning development:
Follow one- or two-step instructions; routine, repetitive task.
Carry out detailed but uninvolved written or verbal instructions; deal with a few concrete
variables.
Follow written, verbal, or diagrammatic instructions; several concrete variables.
X Solve practical problems; variety of variables with limited standardization; interpret instructions.
Logical or scientific thinking to solve problems; several abstract and concrete variables.
Wide range of intellectual and practical problems; comprehend most obscure concepts.</div></div><div><div> 
b. Mathematical development:
Simple addition and subtraction; copying figures, counting, and recording.
Add, subtract, multiply, and divide whole numbers.
X Arithmetic calculations involving fractions, decimals, and percentages.
Arithmetic, algebraic, and geometric calculations.
Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
Highly complex mathematical and statistical techniques, such as calculus, factor analysis, and probability determination; requires theoretical application.</div></div><div><div> 
c. Language development:
Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; and guide people and provide basic direction.
X Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
Ability to report, write, or edit articles for publication; prepare deeds, contracts, or leases; prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.</div></div><div><div> 
2. PHYSICAL EFFORT
a. Physical activity required to perform the job:
Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
X Light work:
a. Exerting up to 20 pounds of force occasionally
b. Exerting up to 10 pounds frequently
c. Exerting a negligible amount of force constantly to move objects
(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).
Medium work:
a. Exerting up to 50 pounds of force occasionally
b. Exerting up to 20 pounds of force frequently
c. Exerting up to 10 pounds of force constantly to move objects
Heavy work:
a. Exerting up to 100 pounds of force occasionally
b. Exerting up to 50 pounds of force frequently
c. Exerting up to 20 pounds of force constantly to move objects
Very heavy work:
a. Exerting in excess of 100 pounds of force occasionally
b. Exerting in excess of 50 pounds of force constantly to move objects
c. Exerting in excess of 20 pounds of force constantly to move objects 
</div></div> 
<div><div><ul><li>Visual requirements necessary to perform the job:</li></ul>
Far vision: clarity of vision at 20 feet or more
X Near vision: clarity of vision at 20 inches or less
X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Color vision: ability to identify and distinguish colors
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
</div></div> 
</div><div><div>2. PHYSICAL EFFORT (cont.) 
FREQUENCY</div><div><div> 
c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):
Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.
Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
X Kneeling: Bending legs at knee to come to a rest on knee or knees.
X Crouching: Bending the body downward and forward by bending legs and spine.
Crawling: Moving about on hands and knees or hands and feet.
X Reaching: Extending hand(s) and arm(s) in any direction.
X Standing: Particularly for sustained periods of time.
X Walking: Moving about on foot to accomplish tasks, particularly for long distances.
X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.
X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Foot
Motion: Using feet to push pedals.
X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.
X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.
X Grasping: Applying pressure to an object with the fingers and palm. 
</div><div>Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Frequently
Occasionally
</div></div> 
</div><div><div>2. PHYSICAL EFFORT (cont.) 
FREQUENCY</div><div><div> 
X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.
Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
X Repetitive Substantial movements (motions) of the wrists, hands,
Motion: and/or fingers.</div><div> 
Frequently
Frequently
Frequently 
</div></div> 
<div><div>3. WORKING CONDITIONS
Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. 
</div></div> 
<div><div>WORKING CONDITION
ENVIRONMENTAL
FACTOR</div><div> 
NATURE/REASON
OF EXPOSURE</div><div> 
FREQUENCY</div></div><div> 
Dirt/Dust 
</div> 
<div>Noise 
</div> 
<div>Temperature extremes 
</div> 
<div>Dampness 
</div> 
<div>Vibrations 
</div> 
<div>Equipment movement hazard 
</div> 
<div>Chemicals/solvents 
</div> 
<div>Electrical shock 
</div> 
<div>Significant work pace/pressure 
</div> 
<div>Odors/Fumes 
</div> 
<div><div>Other (specify): 
</div></div> 
 
</div>Signatures:
This job description has been approved by all levels of management:
Human Resources: ___________________
The employee's signature below constitutes the employee's understanding of the mental and physical requirements, essential functions, and duties of the position.
Employee____________________________ Date____________________</div>

Claims Examiner III (Hybrid)

<div>Overview: 
Our client, the largest Third Party Administrator in North America is looking for an experienced Claims Adjuster to handle Workers Compensation Claims. At the direction of the Claims Supervisor and/or Claims Manager, the Claims Adjuster/Examiner II / III manages all aspects of workers&rsquo; compensation indemnity, medical-only, future medical, and litigated claims from inception through resolution, within established authority and company/client guidelines. This role requires frequent interaction with clients, claimants, medical providers, attorneys, vendors, nurse case managers, vocational case managers, and internal staff. The level of complexity, litigation exposure, settlement authority, and leadership responsibility will be commensurate with the examiner&rsquo;s experience and designation (Level II or Level III). 
 
What you will be doing: 
Applies to Examiner II &amp; III<ul><li>
Manage a full caseload of workers&rsquo; compensation claims, including complex indemnity claims.</li><li>
Initiate, conduct, and document timely and thorough claim investigations.</li><li>
Determine compensability and administer benefits in accordance with state laws, rules, and company/client handling instructions.</li><li>
Manage medical treatment and medical billing; authorize services as appropriate.</li><li>
Communicate effectively with claimants, medical providers, vendors, and clients regarding claim issues.</li><li>
Compute and set reserves in accordance with Company and Client guidelines.</li><li>
Maintain an organized diary system and document claim files to reflect status, strategy, and action plans.</li><li>
Settle and/or finalize claims and obtain appropriate settlement authority.</li><li>
Conduct scheduled file reviews and respond to client inquiries.</li><li>
Identify injury trends, safety concerns, and other claim-related issues and communicate proactively to clients.</li><li>
Adhere to all company policies, procedures, and best practices.</li><li>
Utilize office systems and technology efficiently to manage caseload responsibilities.</li><li>
Perform other related duties as assigned.</li></ul>
Advanced / Senior Responsibilities (Primarily Examiner III)<ul><li>
Manage very complex, catastrophic, and litigated indemnity claims from inception to conclusion.</li><li>
Refer cases to outside defense counsel and actively participate in litigation strategy, hearings, mediations, and settlements.</li><li>
Identify and manage:<ul><li>
Subrogation opportunities</li><li>
Apportionment potential</li><li>
Excess reporting criteria and reimbursement</li></ul></li><li>
Prepare and assist with state audits, regulatory reporting, and client-specific reporting requirements.</li><li>
Develop and execute proactive claim strategies to drive timely and cost-effective resolution.</li><li>
Conduct detailed client file reviews and participate in client meetings as needed.</li><li>
Mentor and provide technical guidance to less experienced Claims Examiners.</li><li>
Handle multi-jurisdictional workers&rsquo; compensation claims as assigned.</li></ul> 
What you will be doing: 
Education &amp; Experience 
Claims Examiner II:<ul><li>
Bachelor&rsquo;s degree in a related field (preferred)</li><li>
Minimum 3+ years of workers&rsquo; compensation claims experience, or equivalent combination of education and experience</li></ul>
Claims Examiner III:<ul><li>
Minimum 5+ years of progressive workers&rsquo; compensation claims experience</li><li>
Demonstrated experience handling complex and litigated indemnity claims</li></ul>
Knowledge, Skills &amp; Abilities<ul><li>
Strong technical knowledge of workers&rsquo; compensation statutes, regulations, and medical terminology</li><li>
Ability to independently analyze and manage complex claims</li><li>
Excellent written and verbal communication skills</li><li>
Ability to convey technical information to claimants, clients, and internal stakeholders</li><li>
Strong organizational, analytical, and time-management skills</li><li>
Ability to interact professionally with individuals at all levels of the business environment</li><li>
Proficiency in Microsoft Word and Excel (preferred)</li></ul>
Certifications / Licenses<ul><li>
Hawaii Workers Compensation Adjusters License</li></ul> 

#Workwolf</div>

Workers Compensation Claims Examiner II/III - Hybrid

TEEMA Group

<div>Role Summary
The Claims Examiner II/III is a senior-level professional responsible for managing the full lifecycle of workers&rsquo; compensation indemnity claims, from inception through resolution, within established authority and guidelines. This role handles highly complex claims and plays a critical part in ensuring compliance with state regulations, timely investigations, accurate reserving, and effective claim resolution. The position requires strong analytical judgment, excellent communication skills, and consistent collaboration with clients, claimants, vendors, legal counsel, and internal teams.
This is an excellent opportunity for an experienced claims professional seeking autonomy, complexity, and impact in a hybrid work environment.
 Duties and Responsibilities<ul><li>
Manage a caseload of approximately 125&ndash;150 workers&rsquo; compensation claims, including highly complex and litigated files.</li><li>
Handle claims within Pennsylvania and New Jersey jurisdictions in compliance with applicable state laws and company guidelines.</li><li>
Initiate and conduct timely, thorough investigations to determine compensability.</li><li>
Administer benefits and manage claims in accordance with statutory requirements and organizational policies.</li><li>
Oversee medical treatment and medical billing, authorizing services as appropriate.</li><li>
Refer claims to outside defense counsel and direct legal strategy as needed.</li><li>
Communicate effectively with claimants, medical providers, vendors, clients, and internal stakeholders regarding claim status and issues.</li><li>
Establish and manage claim reserves within company guidelines, with higher authority limits than lower-level examiner roles.</li><li>
Negotiate, settle, and finalize claims, obtaining appropriate settlement authority when required.</li><li>
Maintain accurate and well-documented claim files, including diary systems for timely case review.</li><li>
Proactively communicate relevant information to clients to promote efficient claim resolution and identify injury trends or safety concerns.</li><li>
Collaborate with loss control staff when appropriate to address risk management opportunities.</li><li>
Conduct independent file reviews to ensure quality, compliance, and best practices.</li><li>
Adhere to all company policies, procedures, and performance standards.</li><li>
Perform other related duties as assigned.</li></ul>
 Required Qualifications<ul><li>
Bachelor&rsquo;s degree in a related field (preferred).</li><li>
Minimum of three (3) years of workers&rsquo; compensation claims experience, or an equivalent combination of education and experience.</li></ul><ul><li>
Strong technical knowledge of workers&rsquo; compensation statutory regulations and medical terminology.</li><li>
Advanced analytical and problem-solving skills.</li><li>
Excellent written and verbal communication skills, with the ability to clearly explain technical concepts to claimants, clients, and colleagues.</li><li>
Proven ability to interact professionally with individuals at all levels of an organization.</li><li>
Ability to independently manage highly complex and high-exposure claims with minimal supervision.</li><li>
Proficiency in Microsoft Word and Excel (preferred).</li></ul>
 Desired Qualifications<ul><li>
Experience handling multi-state workers&rsquo; compensation claims.</li><li>
Prior experience managing litigation and working closely with defense counsel.</li><li>
Demonstrated success in settlement negotiation and reserve management.</li></ul>
Location and Work Type<ul><li>
Work Type: REMOTE</li><li>
Office Presence: Regular, timely attendance in the office is required due to the collaborative and client-facing nature of the role</li></ul>
If you're interested, please reply to this advertisement or directly email your resume to me at DSalgado@teemagroup.com or by calling/texting (949) 295-5951.
I strive to reply within 48 hours. Looking forward to connecting with you soon. Thank you!
#Workwolf</div>

Workers Compensation Claims Examiner II/III

<div><h2 class="jobSectionHeader">Workers&rsquo; Compensation Claims Adjuster (Level II or III) &ndash; Hawaii</h2>
Location: Kapolei, HI (Hybrid for local candidates | Remote for candidates outside the island but must be in Hawaii)<h3 class="jobSectionHeader">
Position Summary</h3>
A leading Third Party Administrator is seeking an experienced Workers&rsquo; Compensation Claims Adjuster to manage a diverse caseload of Hawaii workers&rsquo; compensation claims. Reporting to Claims Leadership, this role is responsible for end-to-end claim ownership&mdash;from intake and investigation through resolution&mdash;while operating within established authority levels and client guidelines.
This position involves regular collaboration with injured workers, employers, medical providers, attorneys, vendors, and internal partners. Claim complexity, litigation exposure, settlement authority, and leadership expectations will align with the Adjuster&rsquo;s level (Examiner II or Examiner III).<h3 class="jobSectionHeader">
Core Responsibilities (Examiner II &amp; III)</h3><ul><li>
Oversee a full inventory of workers&rsquo; compensation claims, including medical-only, indemnity, future medical, and litigated files</li><li>
Conduct prompt and comprehensive claim investigations; document findings thoroughly and accurately</li><li>
Evaluate compensability and administer benefits in compliance with Hawaii statutes and applicable claim-handling instructions</li><li>
Coordinate medical care, authorize treatment, and manage medical billing activity</li><li>
Serve as the primary point of contact for claimants, employers, providers, vendors, and clients</li><li>
Establish, review, and adjust claim reserves in accordance with company and client standards</li><li>
Maintain detailed claim notes, action plans, and diary entries reflecting claim strategy and progress</li><li>
Negotiate, resolve, and close claims within assigned settlement authority</li><li>
Perform regular file reviews and respond to client inquiries in a timely manner</li><li>
Identify emerging trends, risk indicators, and safety concerns; communicate insights proactively</li><li>
Utilize claims systems and internal technology to manage workload efficiently</li><li>
Comply with all internal policies, procedures, and best practices</li><li>
Complete additional duties as assigned</li></ul><h3 class="jobSectionHeader">
Advanced / Senior-Level Responsibilities (Primarily Examiner III)</h3><ul><li>
Independently manage highly complex, catastrophic, and litigated workers&rsquo; compensation claims</li><li>
Retain and collaborate with defense counsel; actively participate in hearings, mediations, and settlement negotiations</li><li>
Evaluate and pursue:<ul><li>
Subrogation opportunities</li><li>
Apportionment considerations</li><li>
Excess coverage reporting and reimbursement</li></ul></li><li>
Support regulatory compliance through audit preparation and state-required reporting</li><li>
Develop proactive claim strategies focused on timely, cost-effective resolution</li><li>
Participate in client file reviews and meetings as requested</li><li>
Provide mentoring and technical support to junior Claims Examiners</li><li>
Handle multi-jurisdictional claims when assigned</li></ul><h3 class="jobSectionHeader">
Qualifications</h3><h4 class="jobSectionHeader">
Education &amp; Experience</h4>
Claims Examiner II<ul><li>
Bachelor&rsquo;s degree in a related discipline preferred</li><li>
3+ years of workers&rsquo; compensation claims experience, or an equivalent combination of education and experience</li></ul>
Claims Examiner III<ul><li>
5+ years of progressive workers&rsquo; compensation claims experience</li><li>
Proven experience managing complex and litigated indemnity claims</li></ul><h3 class="jobSectionHeader">
Knowledge, Skills &amp; Abilities</h3><ul><li>
Strong working knowledge of workers&rsquo; compensation laws, regulations, and medical terminology</li><li>
Ability to independently assess risk, analyze complex issues, and manage claims strategically</li><li>
Clear, professional written and verbal communication skills</li><li>
Strong organizational, analytical, and time-management capabilities</li><li>
Ability to communicate effectively with diverse stakeholders at all organizational levels</li><li>
Proficiency with Microsoft Word and Excel preferred</li></ul><h3 class="jobSectionHeader">
Licensure</h3><ul><li>
Active Hawaii Workers&rsquo; Compensation Adjuster License required</li></ul>
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Claims Supervisor - Workers Compensation

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Claims Supervisor - Workers Compensation