Senior Workers' Comp Claims Examiner (Remote)

TEEMA; Kapolei (HI); Remote; USD 75,000 - 95,000; Full time

Job summary

TEEMA is seeking a senior Claims Examiner II/III to manage a heavy caseload of workers' compensation indemnity claims in a remote environment. The role requires strong analytical judgment, regulatory compliance, and collaboration with clients, claimants, vendors, and legal counsel.

You will handle highly complex and litigated files, establish reserves, coordinate investigations, medical treatment, settlements, and ensure timely case reviews while maintaining documentation and quality standards.

Qualifications

• Bachelor's degree in a related field preferred.
• Minimum of three years of workers' compensation claims experience.
• Strong knowledge of workers' compensation regulations and medical terminology.
• Excellent written and verbal communication; ability to explain complex concepts clearly.
• Ability to independently manage highly complex, high-exposure claims with minimal supervision.

Responsibilities

• Manage a caseload of approximately 125–150 workers' compensation claims, including highly complex and litigated files.
• Handle claims within Pennsylvania and New Jersey jurisdictions in compliance with state laws and company guidelines.
• Initiate and conduct timely investigations to determine compensability.
• Administer benefits and manage claims per statutory requirements and policies.
• Oversee medical treatment and medical billing, authorizing services as appropriate.
• Refer claims to outside defense counsel and direct legal strategy as needed.
• Communicate with claimants, providers, vendors, clients, and internal stakeholders on status and issues.
• Establish and manage claim reserves within guidelines with higher authority limits.
• Negotiate, settle, and finalize claims with appropriate settlement authority.
• Maintain accurate claim files with diary systems for timely review.
• Proactively inform clients to promote efficient resolution and identify injury trends.
• Collaborate with loss control staff to address risk management opportunities.
• Conduct independent file reviews to ensure quality and compliance.
• Adhere to company policies, procedures, and performance standards.

Skills

Analytical skills

Communication skills

Microsoft Word

Microsoft Excel

Education

Bachelor's degree in a related field

Tools

Microsoft Word

Microsoft Excel

Job description

TEEMA is seeking a senior Claims Examiner II/III to manage a heavy caseload of workers' compensation indemnity claims in a remote environment. The role requires strong analytical judgment, regulatory compliance, and collaboration with clients, claimants, vendors, and legal counsel.

You will handle highly complex and litigated files, establish reserves, coordinate investigations, medical treatment, settlements, and ensure timely case reviews while maintaining documentation and quality standards.