worker's compensation claims examiner

TEEMA

<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>Claims Examiner III &ndash; Workers&rsquo; Compensation
Role Summary
The Claims Examiner III is responsible for independently managing the full lifecycle of Workers&rsquo; Compensation indemnity claims, from initial reporting through final resolution. Operating with minimal supervision, this role requires strong analytical judgment, regulatory knowledge, and a commitment to delivering timely, accurate, and compliant claim outcomes.
This position plays a critical role in supporting employers and injured employees by ensuring claims are handled with professionalism, urgency, and integrity. The ideal candidate is organized, service-oriented, and confident in navigating complex claim scenarios within established authority levels and statutory guidelines.
This is an excellent opportunity for an experienced claims professional seeking autonomy, responsibility, and meaningful impact in a structured and collaborative office environment.
Duties &amp; Responsibilities<ul><li>
Manage loss-time Workers&rsquo; Compensation claims within Texas jurisdiction from inception through closure</li><li>
Investigate, evaluate, and determine compensability in accordance with statutory regulations and internal guidelines</li><li>
Administer and issue benefit payments accurately and within required timelines</li><li>
Ensure compliance with all applicable state laws, regulatory standards, and client-specific handling instructions</li><li>
Prepare detailed, formal captioned reports that meet client documentation requirements</li><li>
Communicate effectively and professionally with clients, claimants, employers, attorneys, and internal stakeholders</li><li>
Provide exceptional customer service while assisting employers and injured employees in understanding the Workers&rsquo; Compensation process</li><li>
Maintain organized, accurate claim files and documentation</li><li>
Demonstrate strong time management and sense of urgency in claim handling</li><li>
Collaborate with management and fellow claims professionals to ensure consistent, high-quality outcomes</li><li>
Consistently maintain on-site office attendance in a timely manner to support team operations and client engagement</li><li>
other duties as assigned</li></ul>
Required Qualifications<ul><li>
High School Diploma or GED required</li><li>
Minimum five (5) years of related Workers&rsquo; Compensation claims handling experience, or equivalent combination of education and experience</li><li>
Current Texas Workers&rsquo; Compensation Adjuster License</li><li>
Strong knowledge of Texas Workers&rsquo; Compensation statutes and indemnity claim handling</li><li>
Ability to manage claims independently with minimal supervision</li><li>
Excellent written and verbal communication skills</li><li>
Strong organizational skills and attention to detail</li><li>
Professional demeanor with a positive, team-oriented attitude</li><li>
Ability to interact effectively with clients, claimants, and internal teams</li></ul>
Desired Qualifications<ul><li>
Bachelor&rsquo;s degree in Business, Risk Management, Insurance, or related field (preferred)</li><li>
Experience handling complex or high-exposure indemnity claims</li><li>
Demonstrated ability to prepare formal client-ready reports</li><li>
Proven track record of delivering high-quality customer service</li><li>
Strong problem-solving and decision-making skills</li></ul>
About the Organization
This organization is a professional risk management and claims administration firm committed to delivering responsive, compliant, and high-quality claims services. The culture emphasizes accountability, collaboration, and client satisfaction while empowering employees with the autonomy and support needed to succeed.
Location &amp; Work Type
On-site position in an office environment.
Full-time, exempt role. Regular in-office attendance is required due to the collaborative and client-facing nature of the position.
#Workwolf</div>

Claims Examiner III

<div>Job Summary
Workers Compensation Claims Examiner III
TeemaGroup
Full-time- CONTRACT 3-4 months could be longer
In-Office | Irving, TX, United States<ul><li> 
POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. 
 
This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position. 
 
DUTIES AND RESPONSIBILITIES: 
Handle loss time Workers&rsquo; Compensation claims in TX Office&mdash;Texas Jurisdiction 
Handle claims as per Best Practices, SOC 1 and client Claims Handling Instructions 
The ability to prepare a formal captioned report on claims meeting client requirements 
Well organized and CAN-DO attitude. 
Ability to effectively communicate in a professional manner 
Provide great customer service 
Assist employers and their employees understand the Workers&rsquo; Compensation process 
Investigate, evaluate, determine compensability, pay benefits timely as required and 
comply with all statutory requirements 
A good sense of urgency 
Ability to get along well with others with a positive attitude 
 
EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment. 
 
SPECIAL EQUIPMENT OR CLOTHING: Follow company dress code 
 
QUALIFICATIONS REQUIRED: 
 
Education/Experience: High School Diploma or GED required; Bachelor&rsquo;s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience. 
 
Other Qualifications: 
Workers&rsquo; Compensation Adjusters License for the State of Texas</li></ul>
QUALIFICATIONS REQUIRED
Education &amp; Experience<ul><li>Claims Examiner II:</li><li>Bachelor&rsquo;s degree in a related field (preferred)</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

WCF Insurance

<div>WCF Insurance, an &quot;A&quot; rated insurance carrier, continues to grow and is seeking a motivated professional to join our outstanding Claims team. At WCF, we take pride in our strong culture, comprehensive benefits, and collaborative environment.
Our team is committed to delivering exceptional customer service to our policyholders and agents. We support our adjusters with caseloads well below industry standards, allowing the time and focus needed to manage claims effectively. In addition, our proprietary claims system-designed by claims professionals-prioritizes efficiency, usability, and strong claim outcomes. 
Position Overview
The Claims Department has an immediate opening for a Worker's Compensation Disability Adjuster to manage claims in Utah and Nevada. This is a full time, exempt position that offers the opportunity for hybrid work (3 days per week in office, based on location.)
This role may be filled at the Disability Adjuster or Senior Adjuster level, based on experience and qualifications.
Candidates must reside within 50 miles of one of the following offices:<ul><li>
Sandy, Utah</li><li>
St. George, Utah</li><li>
Las Vegas, Nevada</li></ul>
All new hires are required to attend onboarding at our home office in Sandy, Utah for their first week of employment with WCF Insurance. Training will then continue in person at the designated office location. 
Key Responsibilities<ul><li>
The Worker's Compensation Disability Adjuster is responsible for managing claims from initial report through resolution, including:</li><li>
Investigating claims, documenting findings, and determining coverage and liability</li><li>
Managing industrial accident and occupational disease claims</li><li>
Reviewing and interpreting medical records and supporting documentation</li><li>
Coordinating the legal, medical, and disability components of each claim</li><li>
Collaborating with injured workers, policyholders and agents, medical providers and vendors, internal WCF departments, and Jurisdictional Divisions of Industrial Relations and other stakeholders.</li><li>
Ensuring compliance with all applicable statutory and regulatory requirements</li></ul> 
Qualifications
The ideal candidate will have:<ul><li>
Minimum of 2 years of workers' compensation disability adjusting experience</li><li>
Strong understanding of Nevada DIR rules and procedures and/or Utah statutes and regulations</li><li>
Working knowledge of medical terminology</li><li>
Excellent communication and interpersonal skills</li><li>
Strong investigative, organizational, and analytical abilities</li><li>
High attention to detail</li><li>
Multi-line claims experience (preferred)</li></ul>
Licensing Requirement: Candidates residing outside Nevada must obtain a Nevada adjuster license within 45 days of hire, as required by state law.
Internal applicants must have at least six months in their current role, maintain acceptable performance, and notify their current supervisor prior to applying. 
Benefits
WCF Insurance offers an extensive compensation package. Benefits include Medical, Dental, and Vision insurance, company paid life insurance, 401K with a generous 6% employer match and additional benefits such as an Employee Assistance Program and time off to volunteer. All employees earn 4 weeks of vacation their first year. 
Compensation<ul><li>
Disability Adjuster: $69,400 - $95,300 annually.</li><li>
Senior Adjuster: $80,000 - $109,900 annually.</li></ul>
Compensation is based on location, experience, and education. 
OUR PEOPLE
WCF strives to provide an excellent work experience and cultivate an inclusive environment where anyone who embodies our values will thrive 
WCF INSURANCE IS AN EQUAL OPPORTUNITY EMPLOYER
WCF Insurance provides equal employment opportunity to all qualified applicants and employees regardless of race, color, religion, sex, age, national origin, veteran status, disability that can be reasonably accommodated, or any other basis prohibited by federal, state, or local law.</div>

Worker's Compensation Disability Adjuster

<div><h2 class="jobSectionHeader">Senior Workers&rsquo; Compensation Claims Examiner (Texas Licensed)</h2>
We are seeking an experienced Workers&rsquo; Compensation Claims Examiner to join a collaborative claims team handling complex indemnity claims from initial investigation through resolution. This is an excellent opportunity for a detail-oriented professional who thrives in a fast-paced environment and enjoys balancing analytical decision-making with strong client and claimant communication.
In this role, you will independently manage a caseload of approximately 110&ndash;150 workers&rsquo; compensation claims, including complex files requiring advanced investigation, compensability analysis, reserve management, and ongoing medical oversight. You will work closely with claimants, employers, medical providers, attorneys, and internal stakeholders to ensure timely and compliant claim resolution in accordance with Texas workers&rsquo; compensation regulations.
Key Responsibilities:<ul><li>
Investigate and manage workers&rsquo; compensation claims from inception to closure</li><li>
Determine compensability and administer benefits in accordance with state laws and company guidelines</li><li>
Coordinate medical treatment and manage related billing activity</li><li>
Establish and maintain accurate claim reserves</li><li>
Maintain organized documentation and diary management for all claim activity</li><li>
Communicate effectively with clients regarding claim status, trends, and risk concerns</li><li>
Conduct independent file reviews and proactively drive claims toward resolution</li></ul>
Qualifications:<ul><li>
Active Texas Workers&rsquo; Compensation Adjuster License required</li><li>
5+ years of workers&rsquo; compensation claims handling experience, including complex indemnity claims</li><li>
Strong understanding of workers&rsquo; compensation statutes, medical terminology, and claims investigation</li><li>
Excellent written and verbal communication skills</li><li>
Ability to manage a high-volume caseload independently</li><li>
Proficiency with Microsoft Office applications preferred</li></ul>
This position offers the opportunity to join a professional, team-oriented environment where your expertise and judgment will have a direct impact on claim outcomes and client satisfaction.
#Workwolf</div>

Workers Compensation Claims Examiner

<div>Overview: 
We are seeking an experienced Workers&rsquo; Compensation Claims Examiner III to support a high-volume claims environment in Irving, TX. This is a fully on-site position requiring in-office attendance five (5) days per week with no hybrid or remote option available. Under minimal supervision, this role is responsible for managing all aspects of indemnity claims handling from inception through resolution, within established authority and regulatory guidelines. This position requires consistent in-office collaboration with internal staff, claimants, employers, and leadership to ensure timely and compliant claims administration. 
 
What you will be doing:<ul><li>
Manage Texas loss time Workers&rsquo; Compensation claims from inception to closure</li><li>
Investigate, evaluate, and determine compensability of claims</li><li>
Administer indemnity and medical benefits in compliance with TX statutory requirements</li><li>
Ensure claims handling aligns with internal Best Practices and client handling guidelines</li><li>
Prepare formal captioned reports in accordance with claim requirements</li><li>
Communicate professionally with claimants, employers, attorneys, and internal stakeholders</li><li>
Assist employers and employees in understanding the Workers&rsquo; Compensation claims process</li><li>
Maintain accurate documentation and ensure timely claims processing</li><li>
Provide high-quality customer service throughout the life of the claim</li><li>
Maintain strong organization and sense of urgency in a deadline-driven environment</li></ul>
What you must have:<ul><li>
Active Texas Workers&rsquo; Compensation Adjuster License</li><li>
Minimum of 5+ years of Texas Workers&rsquo; Compensation claims experience</li><li>
Experience managing public entity claims and First Responder claims</li><li>
Strong knowledge of Texas Workers&rsquo; Compensation laws and regulations</li><li>
Excellent written and verbal communication skills</li><li>
Ability to manage multiple claims in a fast-paced environment</li><li>
High School Diploma or GED required</li><li>
Bachelor&rsquo;s Degree in a related field preferred</li></ul>
Other Information: 
Work Environment 
This position requires:<ul><li>
Daily interaction with internal team members and external stakeholders</li><li>
Full-time, on-site attendance</li><li>
Ability to work collaboratively in a professional office setting</li><li>
Use of standard office equipment including computer, copier, and printer</li></ul>
Additional Requirements<ul><li>
Ability to pass background check and drug screening</li><li>
Authorized to work in the United States</li></ul> 
Salary/Rate Range: $36.53 &ndash; $38.46 per hour 
 
Term: 3-4 Month Contract (Potential Extension) 
If you are a talented, experienced Claims Adjuster/Examiner with an active Texas Workers Compensation license looking for a door into a large organization submit your resume now!
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>

POINT C

<div><div>Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market &ndash; to do more for clients &ndash; and take them beyond the standard &quot;Point A to Point B.&quot; We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.</div>
Point C is looking for a detail-oriented and motivated Claims Examiner to join our team. In this role, you'll be responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations. The ideal candidate is analytical, organized, and experienced in self-funded or third-party administration environments.

Primary Responsibilities
<ul>
<li>Adjudicate new claims and process adjustments, including denials upon receipt of additional information</li>
<li>Review and resolve appeals and subrogation/third-party liability cases</li>
<li>Manage individual inventory to ensure timely turnaround and production goals are met</li>
<li>Ensure claims are processed in accordance with stop loss contract terms</li>
<li>Respond to internal and external inquiries via email and other channels within established timeframes</li>
<li>Follow up on missing or incomplete information to ensure claims can be accurately processed</li>
<li>Maintain minimum production, financial, and procedural accuracy standards on a monthly basis</li>
</ul>
Qualifications
<ul>
<li>Experience with Third Party Administrator (TPA) or self-funded claims administration preferred</li>
<li>1-2 years of experience in insurance claims processing required</li>
<li>Experience reviewing and finalizing claim payments for accuracy in accordance with plan policies</li>
<li>Ability to interpret and apply plan documents to ensure accurate claims adjudication</li>
<li>Experience with VBA systems preferred</li>
<li>Working knowledge of CPT and ICD-10 coding</li>
<li>Basic understanding of medical terminology</li>
<li>Strong communication and customer service skills</li>
<li>Proficiency in Microsoft Office and general computer applications</li>
<li>Ability to maintain confidentiality and comply with all company policies and procedures</li>
<li>Able to work independently with minimal supervision</li>
<li>Ability to prioritize, multitask, and work overtime as needed</li>
<li>Associate Degree Preferred</li>
</ul><div><div>Benefits:</div>
<ul><li>Comprehensive medical, dental, vision, and life insurance coverage</li>
<li>401(k) retirement plan with employer match</li>
<li>Health Savings Account (HSA) &amp; Flexible Spending Accounts (FSAs)</li>
<li><div>Paid time off (PTO) and disability leave</div>
</li><li>Employee Assistance Program (EAP)</li></ul> 


Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business&mdash;and our society&mdash;stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.</div></div>

Claims Examiner

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5744 worker's compensation claims examiner jobs Near Me

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