Claims Examiner – Workers' Compensation

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee all facets of a moderately complex claims inventory.

• Engage with policyholders, agents, attorneys, and witnesses to collect information and deliver customer service.

• Conduct investigations into claims to assess exposure, collaborate with experts, and formulate strategic recommendations.

• Utilize mediation, negotiation, denial, litigation, or offers to facilitate claim resolution.

• Adhere to state regulations as well as internal claims handling policies and procedures.

• Collaborate with defense counsel throughout litigation while tracking legal fees and expenses.

• Work alongside cross-functional team members on various projects and processes.

• Identify opportunities for process improvements.

• Ensure the accuracy of claims-system data for regulatory reporting purposes.

• Facilitate knowledge transfer throughout the organization.

• Attend job-related training sessions and stay updated on current case law.

• Prepare and deliver claims status reports.

• Manage, administer, and approve benefits payments to injured workers within designated authority levels.

• Create and modify reserves in line with company policies.

• Resolve claims in a fair and equitable manner while providing timely benefits as mandated by law.

⛳️ Requirements

• A bachelor's degree or an equivalent combination of education and experience is required.

• At least 1–4+ years of relevant claims or claims handling experience.

• Workers’ Compensation certification that meets the minimum standards of training, experience, and skill is required.

• A State Workers Compensation License is required in certain branches.

• WCCA and WCCP certifications are preferred.

• Basic to good understanding of laws and jurisdictional constraints necessary for managing claims.

• Exceptional verbal communication, time management, attention to detail, and organizational skills.

• Capability to learn new technologies.

• Flexibility to adapt to a fast-paced environment.

• Proficiency in reading, analyzing, and interpreting technical and legal documents.

• Ability to compose reports and business correspondence.

• Competence in addressing inquiries or complaints from customers, claimants, and regulatory bodies.

• Skill in presenting information during meetings, to management, and clients.

• Adept at solving practical problems and managing variables with limited standardization.

• Knowledge of workers’ compensation claims handling, reserving, litigation management, and resolution strategies.

🏝️ Benefits

• Competitive benefits package.

• Medical, dental, and vision plans.

• 401K retirement plan with company matching.

• Bonus potential.

• Paid Time Off.

• Paid holidays throughout the year.

• Support for ongoing learning.

• Engaging work that allows you to make a meaningful impact.

• A voice and a sense of belonging.