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>

Acrisure LLC

<div><h2 class="jobSectionHeader">Job Description</h2>
About Acrisure 
A global fintech leader, Acrisure empowers millions of ambitious businesses and individuals with the right solutions to grow boldly forward. Bringing cutting-edge technology and top-tier human support together, we connect clients with customized solutions across a range of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more.
In the last twelve years, Acrisure has grown in revenue from $38 million to almost $5 billion and employs over 19,000 colleagues in more than 20 countries. Acrisure was built on entrepreneurial spirit. Prioritizing leadership, accountability, and collaboration, we equip our teams to work at the highest levels possible.
JOB SUMMARY
Acrisure is seeking a Workers&rsquo; Compensation Claims Examiner to manage California-based workers&rsquo; compensation claims from assignment through resolution. This role is responsible for investigating claims, determining compensability, managing reserves, and coordinating all aspects of the claims process in compliance with California regulations.
Candidates must have direct experience handling workers&rsquo; compensation claims, hold a current California Adjuster Certification, and have experience with self-insured claims through OSIP or hold a CWCP designation. These are required qualifications for this role.
This is a fully remote position; however, candidates must be able to support California-based claims and work hours that may be more aligned with Mountain or Pacific Time business operations.
Responsibilities<ul><li>
Manage a caseload of California workers&rsquo; compensation claims from initial assignment through final resolution</li><li>
Review and evaluate coverage, liability, and compensability in accordance with California Labor Code and regulatory requirements</li><li>
Conduct thorough investigations, including gathering statements, reviewing reports, and analyzing claim documentation</li><li>
Set and manage reserves based on exposure and claim developments</li><li>
Ensure timely and accurate benefit payments and required communications</li><li>
Maintain claim diaries and ensure consistent follow up throughout the life of the claim</li><li>
Coordinate return to work efforts and monitor ongoing claim activity</li><li>
Oversee litigation, including working with defense counsel and participating in claim strategy discussions</li><li>
Negotiate settlements within authority and provide recommendations on cases exceeding authority</li><li>
Identify potential fraud, subrogation, and cost containment opportunities</li><li>
Maintain accurate and compliant documentation within the claims system</li><li>
Communicate effectively with injured workers, employers, medical providers, attorneys, and internal stakeholders</li></ul>
Requirements<ul><li>
3+ years of experience handling workers&rsquo; compensation claims required</li><li>
Current California Adjuster Certification required</li><li>
Experience handling California self-insured workers&rsquo; compensation claims required, including qualification through the California Office of Self-Insurance Plans (OSIP) or holding a Certified Workers&rsquo; Compensation Professional (CWCP) designation</li><li>
Strong knowledge of California workers&rsquo; compensation laws and claims handling practices</li><li>
Experience managing indemnity claims, litigation, and claim resolution strategies</li><li>
Strong analytical, decision making, and problem solving skills</li><li>
Excellent verbal and written communication skills</li><li>
Strong organizational skills and ability to manage multiple claims</li><li>
Ability to work independently in a remote environment</li><li>
Proficiency with Microsoft Office and claims management systems</li></ul>
Education and Licenses<ul><li>
High school diploma or equivalent required</li><li>
Current California Adjuster Certification required</li><li>
OSIP qualification or Certified Workers&rsquo; Compensation Professional (CWCP) designation required</li><li>
Additional education beneficial</li></ul>
#LI-Remote
Pay Details:
The base compensation range for this position is $80,000 - $95,000. This range reflects Acrisure's good faith estimate at the time of this posting. Placement within the range will be based on a variety of factors, including but not limited to skills, experience, qualifications, location, and internal equity.
Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership. 
Why Join Us:
At Acrisure, we&rsquo;re building more than a business, we&rsquo;re building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future.
Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York. 
Employee Benefits
We also offer our employees a comprehensive suite of benefits and perks, including:<ul><li>
Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.</li><li>
Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.</li><li>
Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.</li><li>
Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.</li><li>
&hellip; and so much more!</li></ul>
This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location. 
Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting leaves@acrisure.com.
Final candidates will be required to complete post-offer verification processes related to the role and in accordance with applicable laws. 
California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy. 
Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice. 
Welcome, your new opportunity awaits you.</div>

Summit Administration Services

Senior Workers&rsquo; Compensation Claims ExaminerSummit Administration Services is seeking a senior workers&rsquo; compensation claims examiner to join our team! As a workers&rsquo; compensation claims examiner, you will receive and organize all documents related to the employee and the injury to make a determination regarding the claim. Workers&rsquo; compensation claims examiners abide by client and company guidelines when making claim determinations. The role requires excellent communication and customer service skills, strong motivation and works in a team environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties.About the company:Summit Administration Services (Summit), located in Scottsdale, AZ is a fully licensed Third-Party Administrator for self-funded health plans and risk programs for Tribal Organizations, Rural School Districts, Municipalities, and Commercial clients. Many employers choose to self-fund their employee benefits and risk programs (health plans, wellness programs, dental, vision, workers&rsquo; compensation, etc.), acting as their own insurance providers. Third Party Administrators (TPAs) are employed to manage the plan's operations. Summit is a completely Independent TPA, and helps employers create innovative plans tailored to their employees' needs without having a big insurance company involved.Summit specializes in creating programs for Native American Tribes, Hospitals, and Grant Schools. These entities range in size from 25 to over 18,000 lives and operate on tight budgets in very rural areas where access to healthcare is limited. Summit operates specialized programs that keep insurance costs low and provide first-class service to some of the most underserved communities. Over the 25+ years of working in Indian Country, Summit has delivered tens of millions of dollars in savings on healthcare costs.Specific duties:&middot; Investigates and maintains Workers&rsquo; compensation claims by reviewing coverage and/or liability and securing information necessary to investigate the claim.&middot; Works toward claim resolution by taking full charge of claims from start to finish.&middot; Will affect settlements/reserves within prescribed limits and submits recommendations to supervisor on cases exceeding personal authority.&middot; Ensures that claim payments are issued timely and accurately.&middot; Ensures compliance of claims handling pursuant to all state, legal, statutory and regulatory bodies to comply with all company procedures and requirements.&middot; Maintains a diary of progress on all claims.&middot; Maintains daily contact with physicians, claimants and the Summit client to provide outstanding service, and assist all parties in navigation of the claim process.Required skills:&middot; 3-5 years of experience handling time loss claims&middot; Familiarity with federal and state workers&rsquo; compensation laws and regulations&middot; Excellent verbal and written communication skills&middot; Strong organization and time management skills&middot; Great attention to detail&middot; Must demonstrate an ability to work independently&middot; Must demonstrate a strong knowledge of computers and software&middot; Native American Tribal experience is a plus.Candidates are eligible for the following benefits:&middot; Vacation&middot; Personal Time Benefits&middot; Holidays&middot; Health Insurance&middot; Dental Insurance&middot; Vision Reimbursement&middot; Educational Assistance&middot; Life Insurance&middot; Long-Term Disability&middot; Simple IRA Savings Plan&middot; Flex Spending Account&middot; Health Reimbursement AccountJob Type: Full-timePay: From $57,000.00 per yearBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Flexible schedule</li><li>Flexible spending account</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Parental leave</li><li>Professional development assistance</li><li>Vision insurance</li></ul>Work Location: Hybrid remote in Scottsdale, AZ 85255

Senior 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

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