workers' compensation claims examiner

TEEMA Group

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

PEMCCO

<div>Do you thrive at the intersection of safety, compliance, and people? Join us as a Workers' Compensation Claims Examiner and help drive a safer, healthier workplace for our employees and contractors. In this role, you&rsquo;ll manage workers&rsquo; compensation, DOT/CDL compliance, and drug and alcohol programs while using data analysis to spot risks before they become incidents. You&rsquo;ll partner closely with HR, operations, and stakeholders to build a proactive safety culture, one where accountability, prevention, and continuous improvement are the standard. 
PEMCCO Inc. is a dynamic and innovative organization dedicated to enhancing urban mobility and transforming transit systems. We are committed to delivering high-quality transit solutions that improve the lives of our communities. Join our team of passionate professionals and be part of a company that values integrity, collaboration, and excellence. 
Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time. 
Key Responsibilities: 

Workers Compensation Claims &ndash; Capabilities/Potential Duties:
<ul>
<li>Investigating and managing all workers&rsquo; compensation claims, including those involving operators, mechanics, and CDL-regulated staff.</li>
<li>Ensuring compliance with Maryland Workers Compensations Laws and Regulations; Labor and Employment Laws, and State of Maryland RTW policies and Directives. In conjunctions along with the WC Claim TPA.</li>
<li>Maintaining HIPAA-compliant confidentiality while managing sensitive medical and employment data.</li>
<li>Supporting labor relations by working closely with union representatives to ensure fair, transparent, and contract-compliant processes that are directly related to workers compensations claims and injured employees and return-to-work processes.</li>
<li>Analyze trends in worker injuries, incidents, and claims to identify potential risks before they escalate.</li> 
</ul>
Drug and Alcohol/DOT Compliance &ndash; Capabilities/Potential Duties:
<ul>
<li>Compliance to 49 CFR 655 and 40</li>
<li>Oversight of CDL medical qualifications and DOT driver compliance</li>
<li>Managing return-to-duty and follow-up testing</li>
<li>Administering testing for non&ndash;safety-sensitive positions</li>
<li>Partnering with HR on job classifications and regulatory investigations</li> 
</ul>
Safety Program Development &amp; Data Analysis
<ul>
<li>Collaborate with the Office of Safety to identify workplace risk trends through data analysis and incident tracking.</li>
<li>Assist in designing and implementing new systems and programs to reduce worker injuries, incidents, and resulting claims.</li>
<li>Support development and promotion of safety awareness campaigns based on data trends and areas of elevated risk.</li>
<li>Maintain and report OSHA-mandated records (e.g., 300/301 logs) in compliance with federal requirements.</li>
Participate in corrective action planning and support follow-through to reduce future risk. 
<li>
</li>
</ul><ul><li>Ensure continuous compliance with federal, state, and local laws affecting workforce safety and eligibility.</li>
</ul><ul><li>Reduce operational risk through proactive monitoring and intervention strategies.</li>
</ul><ul><li>Serve as the subject matter expert for workers&rsquo; compensation and DOT compliance.</li>
</ul><ul><li>Strengthen labor-management relationships through consistent and equitable application of policies.</li>
</ul><ul><li>Ability to maintain confidentiality and act with integrity at all times.</li>
</ul><ul><li>Availability to travel locally for site visits, investigations, or field safety visits.</li>
</ul><ul><li>Performs other duties as assigned.</li></ul> 


Tools &amp; Systems Used:
<ul>
<li>Drug &amp; Alcohol Testing Platforms</li>
<li>Workers&rsquo; Compensation Case Management Systems</li>
<li>HRIS / Compliance Systems 
</li>
<li>Microsoft Office Suite</li></ul> 


Competencies:
<ul>
<li>Strong analytical and investigative skills.</li>
</ul><ul><li>Excellent verbal and written communication.</li>
</ul><ul><li>Ability to manage sensitive situations with professionalism and discretion.</li>
</ul><ul><li>Detail-oriented with strong organizational and documentation skills.</li>
</ul><ul><li>Adept at cross-functional collaboration and stakeholder engagement.</li></ul> 


Required Qualifications: 
<ul>
<li>Bachelor&rsquo;s degree in Human Resources, Occupational Health &amp; Safety, Public Administration, Business Administration, or a related field.</li>
<li>Relevant certifications preferred (e.g., SHRM-CP, CHRC, CHSP, ASP, or similar).</li>
<li>3 to 5 years of experience managing workforce compliance programs, preferably in a transit, transportation, or unionized environment.</li>
<li>Experience managing workers&rsquo; compensation claims and familiarity with return-to-work programs.</li>
<li>Working knowledge of DOT, FTA, and FMCSA regulations.</li> 
</ul>
Preferred Qualifications:
<ul>
<li>Bachelor&rsquo;s degree in Human Resources, Occupational Health &amp; Safety, Public Administration, Business Administration, or a related field. 
</li>
<li>3-5 years of experience managing workforce compliance programs, preferably in a transit, transportation, or unionized environment.</li></ul> 


Benefits
<ul>
<li>15 days of Paid Time Off</li>
<li>11 Paid Holidays</li>
<li>Medical, Dental, and Vision</li>
<li>Voluntary Short-Term Disability, Life Insurance, Accident, Critical Illness, Hospital Indemnity, Whole Life Plus, Identity Theft, and Law Assure</li>
<li>401(k)</li>
<li>Employee Assistance Program (EAP)</li> 
</ul>
Compensation
<ul>
<li>$31.25 - $37.50 per hour, depending on experience.</li> 
</ul>
PEMCCO, Inc. is an equal opportunity employer. The Company does not discriminate on the basis of race, color, sex, sexual orientation, gender identity or expression, religion, national origin, age, disability, genetic information, military or veteran status, pregnancy, childbirth, and related medical conditions or any other characteristics protected by applicable federal, state, or local law.</div>

Workers' Compensation Claims Examiner

TEEMA

<div>Job Summary
Workers Compensation Claims Examiner III
TeemaGroup
Full-time
In-Office | Kapolei, HI, United States 
POSITION SUMMARY
At the direction of the Claims Supervisor and/or Claims Manager, the Claims Examiner II / III manages all aspects of workers&rsquo; compensation indemnity, medical-only, future medical, and litigated claims from inception through resolution, within established authority and company/client guidelines.
This role requires frequent interaction with clients, claimants, medical providers, attorneys, vendors, nurse case managers, vocational case managers, and internal staff.
The level of complexity, litigation exposure, settlement authority, and leadership responsibility will be commensurate with the examiner&rsquo;s experience and designation (Level II or Level III).
DUTIES AND RESPONSIBILITIES
Core Responsibilities (Applies to Examiner II &amp; III)<ul><li>Manage a full caseload of workers&rsquo; compensation claims, including complex indemnity claims.</li><li>Initiate, conduct, and document timely and thorough claim investigations.</li><li>Determine compensability and administer benefits in accordance with state laws, rules, and company/client handling instructions.</li><li>Manage medical treatment and medical billing; authorize services as appropriate.</li><li>Communicate effectively with claimants, medical providers, vendors, and clients regarding claim issues.</li><li>Compute and set reserves in accordance with Company and Client guidelines.</li><li>Maintain an organized diary system and document claim files to reflect status, strategy, and action plans.</li><li>Settle and/or finalize claims and obtain appropriate settlement authority.</li><li>Conduct scheduled file reviews and respond to client inquiries.</li><li>Identify injury trends, safety concerns, and other claim-related issues and communicate proactively to clients.</li><li>Adhere to all TRISTAR company policies, procedures, and best practices.</li><li>Utilize office systems and technology efficiently to manage caseload responsibilities.</li><li>Perform other related duties as assigned.</li></ul>
Advanced / Senior Responsibilities (Primarily Examiner III)<ul><li>Manage very complex, catastrophic, and litigated indemnity claims from inception to conclusion.</li><li>Refer cases to outside defense counsel and actively participate in litigation strategy, hearings, mediations, and settlements.</li><li>Identify and manage:</li><li>Subrogation opportunities</li><li>Apportionment potential</li><li>Excess reporting criteria and reimbursement</li><li>Prepare and assist with state audits, regulatory reporting, and client-specific reporting requirements.</li><li>Develop and execute proactive claim strategies to drive timely and cost-effective resolution.</li><li>Conduct detailed client file reviews and participate in client meetings as needed.</li><li>Mentor and provide technical guidance to less experienced Claims Examiners.</li><li>Handle multi-jurisdictional workers&rsquo; compensation claims as assigned.</li></ul>
Essential job functions.
QUALIFICATIONS REQUIRED
Education &amp; Experience<ul><li>Claims Examiner II:</li><li>Bachelor&rsquo;s degree in a related field (preferred)</li><li>Minimum 3+ years of workers&rsquo; compensation claims experience, or equivalent combination of education and experience</li><li>Claims Examiner III:</li><li>Minimum 5+ years of progressive workers&rsquo; compensation claims experience</li><li>Demonstrated experience handling complex and litigated indemnity claims</li></ul>
#Workwolf</div>

Workers Compensation Claims Examiner III

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

Workers Compensation Claims Examiner II/III

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 | Ontario, California
<div><div><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 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.
OFFICE LOCATIONS
 
Ontario, California (2 days in-office, 3 days remote)
PRIMARY PURPOSE OF THE ROLE: To analyze 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: 5 years of claims management experience or equivalent combination of education and experience required.
<ul><li>High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
</li><li>Professional certification as applicable to line of business preferred.
</li></ul>Licensing / Jurisdiction Knowledge: California workers' compensation claims experience required | SIP Preferred
TAKING CARE OF YOU
<ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</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>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 $80,000-$98,000/yr. 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-GC1
</div></div></div>Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles&rsquo; Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
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 | Ontario, California

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Workers Compensation Claims Examiner | Ontario, California