worker's compensation claims examiner

TEEMA

<div><p><b>Job Summary</b></p><p>
Workers Compensation Claims Examiner III</p><p>
TeemaGroup</p><p>
Full-time</p><p>
In-Office | Kapolei, HI, United States</p><p><b><br>
POSITION SUMMARY</b></p><p>
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.</p><p>
This role requires frequent interaction with <b>clients, claimants, medical providers, attorneys, vendors, nurse case managers, vocational case managers, and internal staff</b>.</p><p>
The <b>level of complexity, litigation exposure, settlement authority, and leadership responsibility</b> will be commensurate with the examiner&rsquo;s experience and designation (Level II or Level III).</p><p><b>
DUTIES AND RESPONSIBILITIES</b></p><p><b>
Core Responsibilities (Applies to Examiner II &amp; III)</b></p><ul><li>Manage a full caseload of workers&rsquo; compensation claims, including <b>complex indemnity claims</b>.</li><li>Initiate, conduct, and document timely and thorough claim investigations.</li><li>Determine compensability and administer benefits in accordance with <b>state laws, rules, and company/client handling instructions</b>.</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><p><b>
Advanced / Senior Responsibilities (Primarily Examiner III)</b></p><ul><li>Manage <b>very complex, catastrophic, and litigated indemnity claims</b> 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 <b>state audits, regulatory reporting, and client-specific reporting requirements</b>.</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><p><i>
Essential job functions.</i></p><p></p><p><b>
QUALIFICATIONS REQUIRED</b></p><p><b>
Education &amp; Experience</b></p><ul><li><b>Claims Examiner II:</b></li><li>Bachelor&rsquo;s degree in a related field (preferred)</li><li>Minimum <b>3+ years</b> of workers&rsquo; compensation claims experience, or equivalent combination of education and experience</li><li><b>Claims Examiner III:</b></li><li>Minimum <b>5+ years</b> of progressive workers&rsquo; compensation claims experience</li><li>Demonstrated experience handling <b>complex and litigated indemnity claims</b></li></ul>
#Workwolf</div>

Workers Compensation Claims Examiner III

TEEMA Group

<div><h2 class="jobSectionHeader"><b>Workers&rsquo; Compensation Claims Examiner III</b></h2><p>
 Irving, TX (On-Site)<br>
 $36.53 &ndash; $38.46 per hour<br>
 Contract: 3&ndash;4 Months (Potential Extension)</p><h3 class="jobSectionHeader"><b>
Overview</b></h3><p>
We are seeking an experienced <b>Workers&rsquo; Compensation Claims Examiner III</b> to join a high-volume claims environment in <b>Irving, Texas</b>. This position is <b>fully on-site and requires in-office attendance five (5) days per week</b>.</p><p>
The ideal candidate will have strong expertise handling <b>Texas Workers&rsquo; Compensation indemnity claims</b> and the ability to manage claims from <b>inception through resolution</b> with minimal supervision. This role requires excellent organization, regulatory knowledge, and the ability to collaborate with internal teams, claimants, employers, and legal representatives.</p><p>
This is a great opportunity for an experienced claims professional seeking exposure within a <b>large, well-established organization</b>.</p><p></p><h3 class="jobSectionHeader"><b>
What You Will Be Doing</b></h3><ul><li>Manage <b>Texas Workers&rsquo; Compensation loss-time claims</b> from inception through closure</li><li>Investigate claims to determine <b>compensability and coverage</b></li><li>Administer <b>indemnity and medical benefits</b> in accordance with Texas Workers&rsquo; Compensation regulations</li><li>Evaluate claim exposure and maintain accurate claim documentation</li><li>Prepare <b>formal captioned reports</b> and maintain compliant claim files</li><li>Communicate professionally with <b>claimants, employers, attorneys, and internal stakeholders</b></li><li>Assist employers and injured workers in understanding the <b>Workers&rsquo; Compensation process</b></li><li>Ensure claims handling follows <b>internal best practices and client guidelines</b></li><li>Maintain strong organization while managing a <b>high-volume caseload</b></li><li>Deliver excellent customer service throughout the <b>entire life of the claim</b></li></ul><p></p><h3 class="jobSectionHeader"><b>
What You Must Have</b></h3><p>
✔ <b>Active Texas Workers&rsquo; Compensation Adjuster License</b><br>
✔ <b>5+ years of Texas Workers&rsquo; Compensation claims handling experience</b><br>
✔ Experience handling <b>loss-time claims</b><br>
✔ Experience with <b>public entity and First Responder claims</b> preferred<br>
✔ Strong understanding of <b>Texas Workers&rsquo; Compensation laws and regulations</b><br>
✔ Excellent <b>written and verbal communication skills</b><br>
✔ Ability to manage multiple claims in a <b>fast-paced environment</b><br>
✔ High School Diploma or GED required<br>
✔ Bachelor&rsquo;s Degree preferred</p><p></p><h3 class="jobSectionHeader"><b>
Work Environment</b></h3><ul><li><b>Full-time on-site role (no remote or hybrid)</b></li><li>Collaborative office environment</li><li>Daily interaction with internal teams and external stakeholders</li><li>Use of standard office equipment including computer systems and claims management software</li></ul><p></p><h3 class="jobSectionHeader"><b>
Additional Requirements</b></h3><ul><li>Ability to pass <b>background check and drug screening</b></li><li>Must be <b>authorized to work in the United States</b></li></ul><p></p><h3 class="jobSectionHeader"><b>
Apply Today</b></h3><p>
If you are an experienced <b>Texas Workers&rsquo; Compensation Claims Examiner</b> looking for an opportunity to contribute your expertise in a fast-paced claims environment, we encourage you to <b>apply today</b>.</p><p>
Email your resume</p><p>
mpalkin@teemagroup.com</p>
#Workwolf</div>

Workers Compensation Claims Examiner

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

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

Workers Compensation Claims Examiner II/III

Athens Administrators

<div><div><b>ATHENS POSITION DETAILS</b></div>
<div></div><div><div><div><div><div><b>Position Title:</b></div>
</div><div><div>Assistant Claims Examiner</div><br>
</div></div><br>
<div><div><div><b>Department:</b></div>
</div><div><div>Workers&rsquo; Compensation</div><br>
</div></div><br>
<div><div><div><b>Reports To:</b></div>
</div><div><div>Claims Supervisor</div><br>
</div></div><br>
<div><div><div><b>FLSA Status:</b></div>
</div><div><div>Non-Exempt</div><br>
</div></div><br>
<div><div><div><b>Job Grade:</b></div>
</div><div><div>6</div><br>
</div></div><br>
<div><div><div><b>Career Ladder:
</b></div></div><div><div>Next step in progression could include Future Medical Examiner or Claims Examiner Trainee</div>
</div></div><br>
</div></div><div></div><div><b>ATHENS ADMINISTRATORS</b></div>
<div>Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a &ldquo;Best Place to Work.&rdquo; Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property &amp; Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today!</div>
<div></div><div><b>POSITION SUMMARY</b></div>
<div>Athens Administrators has an immediate need for an experienced Assistant Claims Examiner to support our Workers&rsquo; Compensation department and can be located anywhere in the state of California, however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday &ndash; Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Assistant Claims Examiner will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves.</div>
<div></div><div><b>PRIMARY RESPONSIBILITIES</b></div>
<div>Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:</div>
<div></div><ul><li>Process new claims in compliance with client&rsquo;s Service Agreement</li>
<li>Issue all indemnity payments and awards on time</li>
<li>Process all approved provider bills timely</li>
<li>Prepare objection letters to providers for medical bills; delayed, denied, lacking reports.</li>
<li>Answer questions over the phone from medical providers regarding bills</li>
<li>Contact treating physician for disability status</li>
<li>Contact employer for return-to-work status or availability of modified work.</li>
<li>Contact injured worker at initial set up</li>
<li>Send DWC notices timely</li>
<li>Issue SJDB Notices timely</li>
<li>Request Job Description from Employer</li>
<li>Handle Medical Only claim files</li>
<li>Calculate wage statements and adjust disability rates as required</li>
<li>Keep diary for all delay dates and indemnity payments</li>
<li>Documents file activity on computer</li>
<li>Update information on computer, i.e., address changes, etc.</li>
<li>Schedule appointments for AME, QME evaluations</li>
<li>Send appointment letters, issue TD/mileage, send medical file</li>
<li>Schedule interpreter for appointments, depositions, etc.</li>
<li>Request Employer&rsquo;s Report, DWC-1, Doctor&rsquo;s First Report if needed</li>
<li>Verify mileage and dates of treatment for reimbursement to claimant</li>
<li>Subpoena records</li>
<li>File and serve documents on attorneys, WCAB, doctors</li>
<li>Serve PTP&rsquo;s with medical file and Duties of Treating Physician (9785)</li>
<li>Request PD ratings from DEU</li>
<li>Draft Stipulated Awards and C&amp;R&rsquo;s</li>
<li>Submit C&amp;R, Stipulated Awards to WCAB for approval with documentation</li>
<li>Process checks &ndash; stop payment, cancellations, void, journal payments</li>
<li>Handle telephone calls for examiner as needed</li>
<li>Complete penalty calculations and prepare penalty worksheets</li>
<li>Complete MPN, HCO and/or EDI coding</li>
<li>Complete referrals to investigators</li>
<li>Complete preparation of documents for overnight delivery</li>
<li>Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners</li>
<li>Contact with clients, injured workers, attorneys, doctors, vendors, and other parties</li>
<li>Provide updates of claims status to Senior Claims Examiners and Athens management</li>
<li>Prepare professional, well written correspondence and other communications</li>
</ul>
<div></div><div><b>ESSENTIAL POSITION REQUIREMENTS
</b></div><div>The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.</div>
<ul><li>High School Diploma or equivalent (GED) required for all positions
<ul><li>AA/AS or BA/BS preferred but not required</li>
</ul></li><li>2+ years&rsquo; Claims Assistant experience supporting a workers compensation examiner or team preferred</li>
<li>Medical Only Adjuster designation required</li>
<li>Continuing hours must be current</li>
<li>Mathematical calculating skills</li>
<li>Completion of IEA or equivalent courses</li>
<li>Administrators Certificate from Self-Insurance Plans preferred</li>
<li>Knowledge of workers compensation laws, policies, and procedures</li>
<li>Understanding of medical and legal terminology</li>
<li>Must demonstrate accuracy and thoroughness in work product</li>
<li>Ability to sit for prolonged periods of time</li>
<li>Well-developed verbal and written communication skills with strong attention to detail</li>
<li>Excellent organizational skills and ability to multi-task</li>
<li>Ability to type quickly, accurately and for prolonged periods</li>
<li>Proficient in Microsoft Office Suite</li>
<li>Ability to learn additional computer programs</li>
<li>Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution</li>
<li>Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization</li>
<li>Seeks to include innovative strategies and methods to provide a high level of commitment to service and results</li>
<li>Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner</li>
<li>Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor</li>
<li>Athens&rsquo; operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.</li>
<li>Must be able to reliably commute to meetings and events as required by this position</li>
</ul><div><b>APPLY WITH US</b></div>
<div>We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at http://www.athensadmin.com/careers/job-openings Feel free to include a cover letter if you&rsquo;d like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf</div>
<div></div><div>This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.</div>
<div></div><div>Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.</div>
<div></div><div><b>THANK YOU!</b></div>
<div>We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don&rsquo;t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!</div>
<div></div><div>Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses &amp; certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&amp;D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA &amp; FSA options, 401k (and Roth), Company-Paid STD &amp; LTD and more! Further information about our comprehensive benefits package may be found on our website at <b>https://www.athensadmin.com/careers/why-work-here</b></div></div>

Assistant Claims Examiner

Crawford & Company

<div><div><div><b>We&rsquo;re Hiring: Senior Claims Examiner &ndash; Workers Compensation (California)</b><br>
<br>
 This is an exciting opportunity to join a global leader in claims management and make a meaningful impact through your expertise<br>
<br>
<b>Why You&rsquo;ll Love It Here:</b><br>
 Offers Work From Home Position<br>
 Compensation: $25.15 &ndash; $45.99 (hourly)<br>
 Excellent Crawford Benefits Supporting Financial, Physical &amp; Mental Wellness<br>
 Great Bonus Opportunity<br>
 Generous Employee Referral Bonus Program<br>
️ Access to Multiple Employee Discounts<br>
<br>
We&rsquo;re looking for a <b>Senior Claims Examiner &ndash; Workers Compensation (California)</b> with a passion for claims management to join our team!<br>
 SIP certification is required<br>
 Proven experience handling California Workers Compensation claims<br>
 Strong background in managing advanced, large-loss, and complex cases<br>
<br>
<b>Role Overview:</b><br>
 Investigate and settle advanced, large-loss, and complex claims promptly and equitably with minimal supervision.<br>
 Work within established authority on moderate-to-difficult claims, reviewing coverages, determining liability/compensability, collecting statements and essential information, and settling claims using best practices.<br>
<ul><li>️ Evaluate and set reserves using independent judgment, support litigation preparation with supervisors and defense attorneys, and contribute to team development through training and mentorship.</li></ul></div></div><ul>
<li>Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.</li>
<li>Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel.</li>
<li>Analyzes claims activity and prepares reports for clients/carriers and management.</li>
<li>Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.</li>
<li>Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits.</li>
<li>Develops subrogation and third party recovery potential and follows reclaim procedures.</li>
<li>Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.</li>
</ul><ul><li>Bachelor's degree or equivalent experience required.</li><li>
Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization.</li><li>
Ability to work independently while assimilating various technical subjects..</li><li>
Strong written and oral communication, negotiation and presentation skills.</li><li>
Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects.</li><li>
Effective advanced interpersonal skills to effectively interact with all levels of internal and external clients.</li><li>
Industry Designations: Preferred: IIA, AIC, AEI, and/or CPCU.</li><li>
License Requirements:Per State or Jurisdictional requirements.</li><li>
Workers Compensation (WC) Adjuster License required according to jurisdictional requirements</li></ul><p>
#LI-EM3 #LI-HYBRID</p>
Why Crawford?
<br>
<br>
Because a claim is more than a number &mdash; it&rsquo;s a person, a child, a friend. It&rsquo;s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community &ndash; one claim at a time.
<br>
<br>
At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We&rsquo;re looking for the next generation of leaders to take this journey with us.
<br>
<br>
We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at www.crawco.com.
<br>
<br>
When you accept a job with Crawford, you become a part of the One Crawford family.
<br>
<br>
Our total compensation plans provide each of our employees with far more than just a great salary
<br>
<ul><li>Pay and incentive plans that recognize performance excellence</li>
<li>Benefit programs that empower financial, physical, and mental wellness</li>
<li>Training programs that promote continuous learning and career progression while enhancing job performance</li>
<li>Sustainability programs that give back to the communities in which we live and work</li>
<li>A culture of respect, collaboration, entrepreneurial spirit and inclusion</li>
</ul><i>Crawford &amp; Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford &amp; Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.</i></div>

Sr Claim Examiner-WC (CA)

Sedgwick

<div><p>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.
</p><p></p><p>Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
</p><p>Certified as a Great Place to Work&reg;
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</p><p></p>Workers Compensation Claims Examiner | NY Jurisdiction | Dedicated Client
<p></p><div><p>We are seeking a highly motivated and experienced Workers' Compensation Claims Examiner to join our team. The ideal candidate will have at least 2 years of claims handling experience, with a strong background in New York jurisdictional regulations and processes. This position is responsible for managing and processing workers' compensation claims, ensuring timely and accurate decisions while adhering to all applicable laws and regulations.
</p><p>We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
</p><p></p><p><b>ESSENTIAL RESPONSIBILITIES
</b></p><ul><li><p><b>Independently </b>handle a capped caseload of workers' compensation claims, from inception to resolution, ensuring adherence to company procedures, industry best practices, and regulatory requirements.
</p></li><li><p><b>Ensure </b>compliance with New York workers' compensation laws, including timely filing of reports, adherence to benefit payment timelines, and compliance with statutory requirements.
</p></li><li><p>Negotiate settlements of claims within designated authority to reach claim resolution.
</p></li><li><p>Provide clear and effective communication with the claimant and client.
</p></li><li><p>Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
</p></li><li><p>Maintain accurate and comprehensive records in the claims management system, documenting all actions, decisions, and correspondence related to each claim.
</p></li></ul><p></p><p><b>OFFICE LOCATION
</b></p><p>Hybrid schedule if within 25 miles of Syracuse, NY office (3 days work from home)
</p><p>Remote if outside of 25 miles
</p><p></p><p><b>QUALIFICATIONS
</b></p><ul><li><p><b>Experience:
</b></p><ul><li><p>Minimum of (2) years of workers' compensation claims handling experience.
</p></li><li><p>Experience specifically with New York jurisdictional regulations, including knowledge of New York State Workers' Compensation Board rules and procedures.
</p></li><li><p>Experience with Public Entity claims management.
</p></li></ul></li><li><p><b>Education:
</b></p><ul><li><p>High school diploma or equivalent; a college degree or relevant certifications (e.g., WCCP, AIC) is a plus.
</p></li></ul></li><li><p><b>Skills and Abilities:
</b></p><ul><li><p>Strong understanding of workers' compensation claims processes, policies, and legal requirements in New York.
</p></li><li><p>Excellent written and verbal communication skills.
</p></li><li><p>Strong analytical skills with attention to detail and accuracy.
</p></li><li><p>Ability to manage multiple claims simultaneously and prioritize workload effectively.
</p></li><li><p>Proficiency with claims management software and Microsoft Office Suite (Excel, Word, Outlook).
</p></li><li><p>Ability to negotiate settlements and resolve claims disputes effectively.
</p></li></ul></li></ul><p><b>TAKING CARE OF YOU
</b></p><ul><li><p>Flexible work schedule.
</p></li><li><p>Capped Case Load.
</p></li><li><p>In-depth training.
</p></li><li><p>Sedgwick funded licensing.
</p></li><li><p>Referral incentive program.
</p></li><li><p>Opportunity to work in an agile or remote environment.
</p></li><li><p>Career development and promotional growth opportunities.
</p></li><li><p>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</p></li></ul><p></p><p><i>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 ($85k-$95k). 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.
</i></p><p>#claimsexaminer #claims #hybrid #remote
</p><p></p><p>#LI-RK
</p></div><p></p><p>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
</p><p></p><h2 class="jobSectionHeader"><b>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.</b></h2></div>

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