worker's compensation claims examiner

TEEMA Group

<div>Claims Examiner (Workers&rsquo; Compensation)
Position Summary
Our client is seeking an experienced Claims Examiner to independently manage a full-cycle caseload of workers&rsquo; compensation claim from inception through resolution. This role requires strong technical expertise, sound judgment, and the ability to handle highly complex indemnity claims within established authority limits.
This is a highly interactive role requiring regular communication with clients, claimants, attorneys, medical providers, and internal stakeholders. Consistent, reliable attendance and strong organizational discipline are essential to success.
Key Responsibilities<ul><li>
Manage a caseload of 150&ndash;180 workers&rsquo; compensation claims, including complex indemnity cases</li><li>
Conduct timely and thorough investigations to determine claim compensability</li><li>
Administer benefits in accordance with state regulations and company guidelines</li><li>
Oversee medical treatment plans and authorize medical services and billing as appropriate</li><li>
Coordinate with and manage defense counsel on litigated claims</li><li>
Communicate effectively with claimants, providers, vendors, and clients regarding claim status and issues</li><li>
Establish and maintain appropriate claim reserves within authority guidelines</li><li>
Negotiate and finalize claim settlements within designated authority levels</li><li>
Maintain accurate and up-to-date claim documentation and diary systems</li><li>
Provide clients with timely updates, including injury trends and risk insights</li><li>
Conduct independent file reviews and ensure compliance with internal policies</li><li>
Perform additional duties as assigned</li></ul>
Qualifications
Education &amp; Experience<ul><li>
Bachelor&rsquo;s degree in a related field (preferred)</li><li>
5+ years of workers&rsquo; compensation claims experience or equivalent combination of education and experience 
 
Must have an active California SIP certification - Self Insurance Plans)</li></ul>
Knowledge, Skills &amp; Abilities<ul><li>
Strong knowledge of workers&rsquo; compensation laws and regulations</li><li>
Familiarity with medical terminology and claims processes</li><li>
Excellent analytical and problem-solving skills</li><li>
Strong written and verbal communication skills</li><li>
Ability to manage high-volume, complex caseloads independently</li><li>
Proficiency in Microsoft Office (Word, Excel preferred)</li><li>
Ability to collaborate effectively with stakeholders at all levels</li></ul>
Certifications<ul><li>
Relevant state licenses and/or certifications as required</li></ul>
Work Environment &amp; Physical Requirements<ul><li>
Primarily office-based role requiring extended periods of sitting and computer use</li><li>
Frequent communication via phone and email</li><li>
Occasional light physical activity (lifting, reaching, etc.) consistent with a standard office environment</li></ul>
Why This Opportunity Stands Out
This is not an entry-level examiner role. If you&rsquo;re used to handling basic claims, you&rsquo;ll get exposed here. This role is built for someone who:<ul><li>
Wants ownership of complex files</li><li>
Is confident making decisions within authority</li><li>
Can handle volume without sacrificing quality</li></ul>
If that&rsquo;s you, this is a strong platform to grow and be recognized.
#Workwolf</div>

Workers Compensation Claims Examiner

<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

TEEMA

<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

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

Workers Compensation Claims Examiner II/III

<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!
#Workwolf</div>

<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>

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
Workers Compensation Claims Examiner | NY Jurisdictional Experience | NY Licensing Required
<div>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>Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
</li><li>Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world&rsquo;s most respected organizations.
</li><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.
WORK LOCATIONS
Syracuse, NY
Open to remote if outside of commutable distance to Syracuse, NY*
PRIMARY PURPOSE OF THE ROLE To analyze New York Lost-Time Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements .
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
<ul><li>Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
</li><li>Negotiating settlement of claims within designated authority.
</li><li>Communicating claim activity and processing with the claimant and the client.
</li><li>Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
</li></ul>QUALIFICATIONS
Education &amp; Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Experience: 2 years of claims management experience or equivalent combination of education and experience required.
Jurisdiction Knowledge: New York
Licensing: New York
TAKING CARE OF YOU
<ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</li><li>Opportunity to work in an agile or remote environment.
</li><li>Career development and promotional growth opportunities.
</li><li>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</li></ul>WORK ENVIRONMENT REQUIREMENTS INCLUDE
 
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
Auditory/Visual: Hearing, vision and talking
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 (80K - 88K). 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.
#claimsexaminer #claims #hybrid #LI-REMOTE
</div>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>

Workers Compensation Claims Examiner | NY Jurisdictional Experience | NY Licensing Required

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Workers Compensation Claims Examiner | NY Jurisdictional Experience | NY Licensing Required