claims examiner supervisor

State of Ohio

<div><div>What You'll Do:
Under general direction of the Administrative Officer 2 (AO2) or Program Administrator 2 or 3 (PA2/PA3):<ul><li>
Supervises &amp; directs (assigns &amp; monitors) all work activities for the district / regional office staff, customer service, word processing, claims examining (all 1st &amp; 2nd level hearing issues), &amp; docketing</li><li>
Supervises lower level supervisors (customer service &amp; program administrator 1)</li><li>
Interprets &amp; applies existing workers' compensation laws, IC / BWC rules, policies &amp; procedures &amp; instructs personnel accordingly</li><li>
Follows up verbal instruction with written direction to ensure understanding &amp; compliance</li><li>
Assists staff with the resolution of complex work activities</li><li>
Makes recommendations to AO2, PA2, PA3 or Regional Manager regarding policy &amp; procedure changes to assure the efficient processing of claims</li><li>
Reviews &amp; analyzes all queues in Case Manager, Applications (Action items, Action uploads, Power BI, VSSR, etc.) &amp; Outlook email (ODI / ODIPT, File Drop, etc.) to ensure inventories are current</li><li>
Works with other claims examiner supervisors to resolve claim, word processing, docketing &amp; report issues (open pcn reports, CAS tracking issues, etc.,)</li><li>
Updates information on CAS, ECM &amp; Case Manager as needed. Prepares or routes claims for exparte orders</li><li>
Maintains the risk &amp; representative master files</li><li>
Serves as liaison with central office departments (administration, fiscal, information technology, operations support, security services, customer service (interpreters), medical services, human resources, management planning, &amp; claims support) &amp; the BWC</li><li>
Oversees &amp; resolves all building operational issues: security, maintenance issues, etc., &amp; reports concerns as needed</li><li>
Backs up other district office supervisors or regional program administrators as needed</li></ul>
See the attached position description for more details regarding this position.
Why Work for the State of Ohio
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
<ul>
<li>Medical Coverage</li>
<li>Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period</li>
<li>Paid time off, including vacation, personal, sick leave and 11 paid holidays per year</li>
<li>Childbirth, Adoption, and Foster Care leave</li>
<li>Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)</li>
<li>Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) &amp; Optional Deferred Compensation (Ohio Deferred Compensation)</li>
</ul>
<ul><li>Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.</li></ul>
Qualifications<div>
3 yrs. trg. or 3 yrs. exp. in workers' compensation claims processing operation, 6 mos. of which had to have been as supervisor or lead worker.
 
 
<ul><li>Or in District Offices, 3 yrs exp. as Claims Examiner 2, 16792 or 30 mos. as Claims Examiner 3, 16793.
</li></ul> 
<ul><li>Or equivalent of Minimum Class Qualifications for Employment noted above.
</li></ul> 
Job Skills: Claims Examination</div>

Technical Skills: Claims Examination, Management, Customer Service, Training, Communications

Professional Skills: Attention to Detail, Developing Others, Critical Thinking, Problem Solving, Time Management
Supplemental Information<ul><li>
This position is filled through an assessment consisting of a structured interview. The interview will be administered in person at the Cambridge District Office.</li><li> 
For internal applicants, the position will be filled pursuant to legislation or the provision of the OCSEA/AFSCME Contract.</li><li>
This position may require travel; therefore, the person occupying this position must be able to provide his/her own transportation &amp;/or legally operate a state-owned vehicle.</li><li>
Compensation statement: The hourly wage for this position is not negotiable. For applicants who are not current State of Ohio employees, the starting wage will be the hourly rate listed on this posting. Successful employees will move up a step in the salary range within one year, and in most cases within four to six months, with subsequent step increases occurring annually.</li><li>
ADA Statement: The Industrial Commission is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs, and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws. To request a reasonable accommodation due to a disability please contact the ADA Coordinator, at 614-466-2765 (voice) or by email to: diversity@ic.ohio.gov, as-soon-as possible but at least 14 days prior to the scheduled event.</li><li>
Background Check Information Statement: The final candidate selected for the position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.</li></ul> 
ADA Statement
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
Drug-Free Workplace
The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.</div></div>

Claims Examiner Supervisor - PN 20065810 - Cambridge

Sedgwick

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Team Lead
Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence:
Eden Prairie, MN : 11000 Prairie Lakes Drive Eden Prairie, MN 55344
Dubuque, IA : 4141 Westmark Drive, Dubuque, IA 52002
Cedar Rapids, IA : 333 1st Street SE Ste. 200 Cedar Rapids IA 52401
Coralville, IA: 3273 Ridgeway Drive Coralville IA 52241
Dublin, OH : 5500 Glendon Court Dublin OH 43016
New Albany, OH : 7795 Walton Parkway New Albany, OH 43054
Indianapolis, IN: 8909 Purdue Road Suite 501 Indianapolis, IN 46268
Irving, TX : 2201 W. Royal Lane Suite 125 Irving, TX 75063
Memphis, TN : 8125 Sedgwick Way, Memphis TN 38125
Southfield, MI : 300 Galleria Officentre Southfield MI 48034
Orlando, FL : 12650 Ingenuity Dr Orlando FL 32826
PRIMARY PURPOSE : To supervise the operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims within the teams including frequent diaries on complex or high exposure claims.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Supervises multiple teams of examiners and/or several technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.
</li><li>Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office.
</li><li>Provides technical/jurisdictional direction to examiner reports on claims adjudication.
</li><li>Compiles, reviews, and analyzes management reports and takes appropriate action.
</li><li>Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
</li><li>Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
</li><li>Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.
</li><li>Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
</li><li>Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client.
</li><li>Assures that direct reports are properly licensed in the jurisdictions serviced.
</li><li>Ensures claims files are coded correctly and adequate documentation is made by claims examiners.
</li></ul>ADDITIONAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</li></ul>SUPERVISORY RESPONSIBILITIES
<ul><li>Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
</li><li>Interviews, hires, and establishes colleague performance development plans; conducts colleague performance discussions.
</li><li>Provides support, guidance, leadership and motivation to promote maximum performance.
</li></ul>QUALIFICATIONS
Education &amp; Licensing
 
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.
Experience
 
Six (6) years of claims experience or equivalent combination of education and experience required. Two (2) years of claims supervisory experience preferred.
Skills &amp; Knowledge
<ul><li>Thorough knowledge of claims management procedures and processes for disability
</li><li>Excellent oral and written communication, including presentation skills
</li><li>PC literate, including Microsoft Office products
</li><li>Leadership/management/motivational skills
</li><li>Analytical and interpretive skills
</li><li>Strong organizational skills
</li><li>Excellent interpersonal skills
</li><li>Excellent negotiation skills
</li><li>Ability to work in a team environment
</li><li>Ability to meet or exceed Performance Competencies
</li></ul>WORK ENVIRONMENT
 
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical : Computer keyboarding, travel as required
Auditory/Visual : Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $65,000-$68,000, (eligible SIPP bonus $1,000.00). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
<h2 class="jobSectionHeader">If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</h2></div>

Team Lead

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Claims Team Lead - Workers Compensation - Must Reside in Nevada
Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world&rsquo;s best brands?
<ul><li>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</li><li>Leverage Sedgwick&rsquo;s broad, global network of experts to both learn from and to share your insights.
</li><li>Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
</li><li>Enjoy flexibility and autonomy in your daily work, your location, and your career path.
</li><li>Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
</li></ul>ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
PRIMARY PURPOSE OF THE ROLE: To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.
* Candidates must reside in NEVADA *
<div>ESSENTIAL RESPONSIBILITIES MAY INCLUDE:
</div><ul><li>Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.
</li><li>Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office.
</li><li>Provides technical/jurisdictional direction to examiner reports on claims adjudication.
</li><li>Compiles reviews and analyzes management reports and takes appropriate action.
</li><li>Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
</li><li>Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
</li><li>Reviews reserve amounts on high-cost claims and claims over the authority of the individual examiner.
</li><li>Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
</li><li>Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client.
</li><li>Assures that direct reports are properly licensed in the jurisdictions serviced.
</li><li>Ensures claims files are coded correctly, and adequate documentation is made by claims examiners.
</li><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</li><li>Travel as required. 
</li></ul> 
QUALIFICATIONS
Education &amp; Licensing
<ul><li>Bachelor's degree from an accredited college or university preferred.
</li><li>Nevada Staff Adjusters License obtained within 3 months of hire.
</li></ul><h2 class="jobSectionHeader">Experience
</h2>Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
Licensing / Jurisdiction Knowledge: Nevada
TAKING CARE OF YOU
<ul><li>Flexible Work Schedule
</li><li>Referral Incentive Program
</li><li>Opportunity to work from home
</li><li>Career development and promotional growth opportunities
</li><li>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day 1
</li></ul>As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($73,000 - $90,000). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
<h2 class="jobSectionHeader">If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</h2></div>

Claims Team Lead - Workers Compensation - Must Reside in Nevada

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

TEEMA Group

<div><h3 class="jobSectionHeader">Role Summary</h3>
The Workers&rsquo; Compensation Claims Supervisor is a key leadership role responsible for guiding and overseeing a high-performing claims team in a fast-paced, compliance-focused environment. This position offers the opportunity to combine deep technical expertise in Texas workers&rsquo; compensation with hands-on leadership, mentorship, and client engagement. The Supervisor ensures accurate claims handling, regulatory compliance, exceptional service delivery, and continuous professional development of staff, while serving as a trusted resource for clients and internal partners.
This is an ideal opportunity for an experienced claims leader who thrives in an in-office setting, values accountability and collaboration, and enjoys driving both operational excellence and team success.
<h3 class="jobSectionHeader">Key Duties &amp; Responsibilities</h3><ul><li>
Supervise, mentor, and support Claims Examiners, Claims Assistants, and administrative staff</li><li>
Monitor attendance, performance, evaluations, and address disciplinary matters as needed</li><li>
Review claims activity, including initial reviews, ongoing case management, delays, and denials</li><li>
Approve reserve changes up to $250,000 and payments up to $10,000 in accordance with internal guidelines</li><li>
Conduct comprehensive file reviews to ensure compliance with Texas workers&rsquo; compensation laws, client requirements, and internal procedures</li><li>
Coordinate and lead training sessions related to regulatory updates, internal policies, and best practices</li><li>
Ensure caseloads are appropriately staffed, balanced, and managed efficiently</li><li>
Approve priority payments and sign checks as required</li><li>
Respond professionally and promptly to claimant, vendor, and client inquiries or concerns</li><li>
Monitor vendor performance and recommend or implement panel adjustments as necessary</li><li>
Ensure all client servicing instructions are consistently followed</li><li>
Provide coverage for claims examiners during absences or vacancies</li><li>
Prepare, review, and evaluate monthly client reports</li><li>
Facilitate and participate in internal and external audits</li><li>
Conduct and document educational and training sessions for internal teams and external stakeholders</li><li>
Attend client file reviews and meetings as needed</li><li>
Collaborate with leadership and sales/service teams on RFPs and client service initiatives</li><li>
Adhere to Supervisor Best Practice Guidelines</li><li>
Perform additional duties as assigned to support operational and organizational goals</li></ul><h3 class="jobSectionHeader">
Required Qualifications</h3><ul><li>
High School Diploma or GED</li><li>
Minimum of 5 years of supervisory experience within workers&rsquo; compensation claims</li><li>
Active Texas Adjuster&rsquo;s License</li><li>
Strong working knowledge of Texas workers&rsquo; compensation statutes and regulations</li><li>
Solid understanding of medical terminology</li><li>
Proven experience supervising claims staff in a high-volume environment</li></ul><h3 class="jobSectionHeader">
Desired Qualifications</h3><ul><li>
Bachelor&rsquo;s degree in a related field</li><li>
Experience handling Texas public entity and school district claims (highly preferred)</li><li>
Strong analytical and problem-solving capabilities</li><li>
Ability to manage diary systems, prioritize workload, and meet strict deadlines</li><li>
Excellent written and verbal communication skills</li><li>
Ability to clearly explain complex claims information to claimants, clients, and staff</li><li>
Proficiency in Microsoft Word and Excel</li><li>
Demonstrated ability to manage and mentor employees with varying experience levels</li><li>
Strong interpersonal, leadership, and coaching skills</li><li>
Ability to manage stress, multitask effectively, and maintain focus in a deadline-driven environment</li><li>
Positive, professional attitude with a strong sense of urgency and accountability</li></ul><h3 class="jobSectionHeader">
About the Organization</h3>
This opportunity is with a well-established organization specializing in workers&rsquo; compensation and claims administration services. The organization is committed to regulatory excellence, client satisfaction, and fostering a collaborative, professional work environment that supports growth, leadership development, and long-term career success.
<h3 class="jobSectionHeader">Location &amp; Work Type</h3><ul><li>
Location: Irving, Texas</li><li>
Work Type: On-site, in-office role</li></ul>
#Workwolf</div>

Workers’ Compensation Claims Supervisor

<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

ClaimsPro LP

<div><h1 class="jobSectionHeader">Company:</h1>
ClaimsPro LP - International Programs Group
Property Claims Examiner - Remote (anywhere in the US) 
Reporting to a Claims Supervisor, the Claims Examiner is responsible for investigating and settling property and first party claims and third-party claims, with an emphasis on strong communication and customer service, while utilizing state specific guidelines.
IPG works in the contiguous 48 states, Hawaii, and Puerto Rico handling a variety of claims including, but not limited to auto physical damage, inland marine cargo, dealers' open lot, property damage (commercial and homeowners) and general liability.
Job Responsibilities:<ul><li>
Initiate the investigation of new claims</li><li>
Make liability/coverage decisions</li><li>
Evaluate and negotiate settlements of collision, specified perils, and property damage, as appropriate.</li><li>
Manage and oversee the work of outside adjusters, appraisers and experts.</li><li>
Establish contact with the insured and claimant within established protocol.</li><li>
Recognize coverage issues and bring them to the attention of the supervisor.</li><li>
Develop basic understanding of liability and coverage principles.</li><li>
Recognize state specific laws and claims regulations throughout the United States to insure proper compliance in claims investigation including sending and securing proper documentation.</li><li>
Complete research to determine market value on automobiles and heavy equipment to make recommendations on total loss settlement values using proper state valuation methods.</li><li>
Summarize and make recommendations for disposition of claims in excess of the individual settlement authority.</li><li>
Respond to time sensitive material including but not limited to intercompany arbitration hearings, and department of insurance complaints.</li><li>
Manage a diary system to systematically review and resolve claims within the specified state compliance guidelines.</li><li>
Maintain state license by completing continuing education coursework and/or work towards a claims designation.</li><li>
Handle small claim suits as needed.</li><li>
Other duties as assigned by the claims supervisor</li><li>
Duties may be added, deleted or changed at any time at the discretion of management, formally or informally, either verbally or in writing.</li></ul>
Qualifications, Education and/or Experience
<ul><li>High School Diploma or Equivalent required</li><li>
Bachelor&rsquo;s degree is preferred</li><li>
Experience with Lloyd&rsquo;s of London is considered an asset</li></ul>
Computer Skills<ul><li>
Proficient in Microsoft Office</li><li>
Experience with Xactimate</li></ul>
Certificates, Licenses, Registrations<ul><li>
Able to be licensed in states, countries where necessary</li><li>
AIC designation preferred</li></ul>
Competencies<ul><li>
Use of clear, rational, thinking supported by evidence to audit fees of independent adjusters, appraisers, and other vendors in order to properly manage and pay expense invoices.</li><li>
Strong writing skills and proper use of grammar to prepare written status reports for the principal. Document claim file notes clearly with all communications and activities that occur during of handling the claim using factual and objective information.</li><li>
Ability to plan and exercise conscious control over the amount of time spent on specific activities.</li><li>
Strong Communicator (verbal and written)</li><li>
Ability to multi-task and handle high volume of concurrent tasks</li><li>
Work collaboratively with others inside and outside the company</li></ul>
Environment/Working Conditions:<ul><li>
Dynamic environment with tight deadlines, number and changing priorities</li><li>
All prospective employees must pass a background check</li><li>
Office environment including prolonged periods of computer use</li><li>
Location: Remote working but may require some travel to home office, etc.</li></ul>
We welcome and encourage applications from people with disabilities. Accommodation is available on request for candidates throughout the recruitment and assessment process.
Unsolicited Outreach Statement &ndash; Recruitment Agencies
We will not accept unsolicited resume submittals from third- party recruiters and hereby request agencies not to contact our employees or managers directly to present candidates. Be advised we will NOT pay a fee for any placement resulting from the receipt of an unsolicited resume and will consider any unsolicited resumes forwarded public information. We welcome resumes submitted directly from candidates.</div>

Property Claims Examiner - Remote

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