Claims Examiner Workers Compensation I
New
Based in the United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- Minimum 5 years of claims management or related experience
- Required Skills
- Negotiation
Requirements
- Minimum 5 years of claims management or related experience, or equivalent combination of education and experience.
- High School Diploma or GED required; Bachelor’s degree preferred from an accredited institution.
- Experience handling workers’ compensation claims, preferably within FL, GA, LA, SC, NC, or TX jurisdictions.
- Strong understanding of claims adjudication processes, regulatory frameworks, and insurance best practices.
- Excellent analytical, negotiation, and decision-making skills with strong attention to detail.
- Effective communication skills with the ability to manage sensitive conversations professionally and empathetically.
- Relevant professional certifications are a plus depending on jurisdictional requirements.
Responsibilities
- Analyze, investigate, and manage workers’ compensation claims from intake through resolution, ensuring compliance with SE jurisdictional regulations and client guidelines.
- Develop and execute action plans to assess claim exposure, determine compensability, and drive timely claim closure.
- Negotiate settlements within delegated authority while balancing cost control and fair claimant outcomes.
- Communicate effectively with claimants, employers, medical providers, and clients to provide updates and clarify claim status.
- Report claims to excess carriers when required and respond promptly to information requests and case direction.
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