Job Description
Job DescriptionJob ProfileJob Title: Claims ExaminerLocation: RemoteHire Type: Contingent Pay Range: $50 Work Model:RemoteWork Shift: Monday-Friday 8 am – 4 pm Recruiter Contact:Sean Craft I sean@marykraft.com I 443-345-3305Nature & Scope:Positional OverviewWe are seeking a highly skilled Workers’ Compensation Claims Examiner with a proven track record in handling complex, high-exposure claims. The successful candidate will possess a deep understanding of workers’ compensation processes, strong analytical skills, and a collaborative mindset. This position may be performed remotely or onsite, offering flexibility to qualified candidates.Role & Responsibility:Tasks That Will Lead to Your Success
- Investigate, analyze, and manage complex and/or technically challenging workers’ compensation claims from start to resolution.
- Establish and execute well-defined action plans that ensure timely and appropriate claim outcomes.
- Accurately calculate and assign reserves; monitor reserve adequacy and make adjustments as necessary.
- Process and issue payments for benefits due in compliance with applicable laws and within authority limits.
- Prepare and submit state filings in accordance with statutory timelines.
- Oversee the litigation process on assigned claims, including coordination with legal counsel and vendor partners.
- Utilize cost containment strategies and approved vendors to control claim-related expenses.
- Manage recovery opportunities including subrogation, Second Injury Fund, and Social Security/Medicare offsets.
- Communicate clearly and professionally with claimants, clients, and internal partners throughout the claim lifecycle.
- Document all claim activity in accordance with internal guidelines and maintain accurate claim coding.
- Escalate complex or sensitive cases to supervisors as needed.
Skills & ExperienceQualifications That Will Help You Thrive
- High School Diploma or GED required.
- Professional certifications (e.g., WCCA/WCCP, AIC) preferred.
- Minimum 5 years of relevant experience handling workers’ compensation claims, preferably in California.
- Experience with litigated claims and complex case management is strongly desired.
- Expert knowledge of workers’ compensation laws, practices, and compliance requirements.
- Proficient in Microsoft Office and claims management systems.
- Strong written and verbal communication skills.
- Excellent negotiation, analytical, and problem-solving abilities.
- High attention to detail and strong organizational skills.
- Ability to work independently and in a collaborative team environment.
- Demonstrated ability to meet or exceed performance and service expectations.