workers' compensation claims examiner

TEEMA Group

<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>

Workers Compensation Claims Examiner

<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>

<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>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

Hereford Insurance Company

<div>Summary
Review and process mail (Board decisions, attorney correspondence, and authorization request). Review and issue timely payments of awards from the Workers' Compensation Board.
Essential Duties &amp; Responsibilities<ul><li>Maintain an open file case load (approximately 150); and a 1:1 closing ratio.</li><li>Handle a case load of catastrophic aims, PPD and high cost claims.</li><li>Provide reserve and settlement authority ($30,000), Refer higher limit Files to the manager for authority.</li><li>Resolve and settle cases with Workers' Compensation attorneys and HIC hearing reps; request appeals where applicable.</li><li>Assign cases for ME, Investigations and Case Management.</li><li>Negotiate and settle outstanding medical bills.</li><li>Settle cases through Section 32 and SLU process.</li><li> Complete 3 point contact (claimant, insured and provider) within 48 hours.</li><li>Timely filing of WCB forms to avoid penalties, Timely processing of Workers' Compensation Board awards.</li><li>Review medical bills for payment and causal relationship.</li><li>Issue timely payments (bi-weekly) including CCP Indemnity and awards, Maintain a daily diary of pending.</li><li>Follow-up with subrogation (loss transfer and 3rd party claims).</li></ul>
Other Duties
This job description in no way states or implies that these are the only cuties to be performed. You will be expected to follow any other job-related instructions and to perform other job-related duties as requested by your supervisor.
Qualifications
At least 5 years proven, current experience as a NY workers' compensation claims examiner/adjuster: detailed working knowledge of the additions to the medical treatment guidelines effective 2014.
Supervisory Responsibilities
Physical Demands
While performing the duties of this job, the employee is frequently required to sit for long periods while using a computer with keyboard, screen and mouse; talk, listen on the telephone and in person; read and write; apply logic and focus attention in the presence of distraction, Occasional requirements are to stand or walk for brief periods,
Training
On-the-job training including but not limited to Imageright and AS400.
Decision Making
Financial Responsibilities
Reserve authority up to $30k.
Communication
Effective verbal, written and interpersonal communication skills.
Results of Action
Successful actions will result in the complete, timely and accurate payments of awards.
Equipment Used
Equipment used is primarily a personal computer, peripherals and related software.
Work Environment
The work environment consists of indoor highly regulated, time sensitive, teamwork environment in a standard office setting utilizing a cubicle as a work station.</div>

WC CLAIMS ADJUSTER

K2 Claims Services, LLC

<div>Property Claims Sr. Examiner
Harrisburg, PA, Harrisburg, PA, US
Salary Range: 85,000.00 To 100,000.00 (USD) Annually
Property Claims Sr. Examiner
This position will be primarily remote with occasional meetings/training in Harrisburg, Pennsylvania.
The preferred candidate will have 10+ years of adjusting/examining homeowner claims in California from an in-house adjusting/examining role. Preferably the candidate will also have experience in handling Large Loss/Complex Claims and Commercial Claims. The candidate should be a self-starter and motivated to help build a world-class TPA.
K2 Claims is a third-party administrator who handles claims nationwide for various insurance carriers. The Claims Team specializes in claims handling meeting the unique needs of the insurance market.
K2 Claims is a subsidiary of K2 Insurance Services, LLC and is expanding its product offerings and distribution by developing new insurance programs and increasing the number and geographic diversity of its marketing, sales, and support staff.
K2 Claims offers the opportunity to join a company in growth mode. Our pay and benefits program includes competitive salary, bonus plan, opportunities for CAT Pay, medical, dental, and vision insurance with no waiting period; paid time-off in year of hire; and 401(k) with employer match.
The Property Claims Sr. Examiner will adjudicate claims from initial intake to final settlement. And will have proper state licensing.
Activities include and not limited to:<ul><li>
Handling claims pursuant to state specific insurance regulations along with K2 Claims&rsquo; Best Practices.</li><li>
Handling Large Loss/Complex Claims as well as general claims.</li><li>
Provide excellent customer service to all stakeholders.</li><li>
Respond to claim calls, emails and requests from agents.</li><li>
Work closely with partners to correctly and efficiently complete coverage evaluations to efficiently resolve claims.</li><li>
Review and negotiate emergency service estimates with vendors.</li><li>
Evaluating and considering all subrogation/salvage opportunities.</li><li>
Utilizing available tools to resolve claims in the most efficient manner possible.</li></ul>
Ideally, the Property Claims Sr. Examiner will have:<ul><li>
Bachelor&rsquo;s degree, preferably in a business or insurance-related major.</li><li>
Exhibit general property and construction knowledge.</li><li>
Exceptional customer service focus.</li><li>
Excellent verbal and written communication skills.</li><li>
Ability to manage multiple tasks in a fast-paced environment.</li><li>
Excellent knowledge in Word, Excel, and Outlook.</li><li>
Flexibility for occasional business travel.</li><li>
Strong time management skills as this job will be based at home with minimal supervision.</li></ul>
Learn more about K2 Claims at k2insclaims.com</div>

Senior Property Claims Examiner - REMOTE

<div><h2 class="jobSectionHeader">Commercial Auto &amp; General Liability Claims Examiner II</h2><h3 class="jobSectionHeader">
Role Summary</h3>
Empower your professional journey in a role that values intellectual curiosity and file ownership over high-volume &quot;churn.&quot; As a Claims Examiner II, you will manage and resolve complex Commercial Auto, No-Fault/PIP, and General Liability claims from initial intake through final disposition. This position is perfect for a strategic thinker who excels at evaluating exposure, guiding investigative strategy, and collaborating with legal counsel to achieve fair and efficient resolutions. You will join a stable, rapidly growing organization that prides itself on autonomy, high-quality claims administration, and a professional work environment.
Key Duties:<ul><li>
Technical Policy Analysis: Review and interpret complex insurance policies to accurately determine liability and coverage exposure.</li><li>
Comprehensive Claims Management: Independently investigate and evaluate Commercial Auto, PIP, and General Liability claims to ensure high-quality outcomes.</li><li>
Litigation Oversight: Direct and coordinate efforts with outside investigators, legal counsel, and various vendors to drive claim strategy.</li><li>
Financial Management: Evaluate total claims exposure to establish and maintain appropriate financial reserves.</li><li>
Negotiation &amp; Settlement: Develop and execute sophisticated settlement strategies and communicate recommendations to key stakeholders.</li><li>
Strategic Reporting: Prepare detailed loss reports that synthesize liability, damages, and coverage issues.</li><li>
Recovery Initiatives: Identify and pursue subrogation and risk transfer opportunities to protect client interests.</li><li>
Professional Communication: Provide elite-level service and maintain transparent communication with both internal and external stakeholders.</li></ul><h3 class="jobSectionHeader">
Required Qualifications</h3><ul><li>
Experience: 2+ years of dedicated experience handling Commercial Auto and General Liability claims.</li><li>
Technical Mastery: Strong understanding of claims handling practices, coverage analysis, and litigation management.</li><li>
Communication: Exceptional written and verbal communication skills.</li><li>
Decision Making: Proven ability to evaluate complex data, make independent decisions, and negotiate effectively.</li><li>
Organizational Skills: Superior time management skills and proficiency with claims management software and standard computer applications.</li></ul><h3 class="jobSectionHeader">
Desired Qualifications</h3><ul><li>
Specialized Expertise: Direct experience managing No-Fault/PIP claims.</li><li>
Education: Bachelor&rsquo;s degree or equivalent professional experience.</li><li>
Jurisdictional Knowledge: Familiarity with multi-jurisdictional claims handling requirements.</li><li>
Remote Proficiency: Ability to work productively and independently in a fast-paced, 100% remote environment.</li></ul><h3 class="jobSectionHeader">
Location and Work Type</h3><ul><li>
Location: 100% Fully Remote</li><li>
Work Type: Full-Time | Direct Hire</li><li>
Schedule: Standard Business Hours</li><li>
Benefits: Full suite of premium benefits, including medical, dental, vision, and Paid Time Off (PTO).</li></ul> 

#Workwolf</div>

Commercial Auto & General Liability Claims Examiner II

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3796 workers' compensation claims examiner jobs Near Me

Workers Compensation Claims Examiner

Workers Compensation Claims Examiner

Workers Compensation Claims Examiner II/III

Claims Examiner III

WC CLAIMS ADJUSTER

Senior Property Claims Examiner - REMOTE

Commercial Auto & General Liability Claims Examiner II