Senior Workers' Comp Claims Examiner (Remote)

TEEMA Group; Kapolei (HI); Remote; USD 70,000 - 95,000; Full time

Job summary

TEEMA Group is seeking a senior Claims Examiner II/III to manage the full lifecycle of workers’ compensation indemnity claims in a challenging, autonomous role.

You will handle highly complex cases, ensure regulatory compliance, and collaborate with clients, claimants, vendors, and legal counsel. This remote-ready position requires strong analytical judgment and advanced communication skills to drive timely resolution.

Qualifications

• Requires a bachelor’s degree in a related field (preferred).
• Minimum of three years of workers’ compensation claims experience or equivalent.
• Strong knowledge of workers’ compensation statutory regulations and medical terminology.
• Excellent written and verbal communication with ability to explain technical concepts clearly.
• Ability to independently manage highly complex and high-exposure claims with minimal supervision.

Responsibilities

• Manage a caseload of 125–150 workers’ compensation claims, including complex and litigated files.
• Investigate to determine compensability and administer benefits per state law.
• Oversee medical treatment and billing; authorize services as appropriate.
• Refer claims to outside defense counsel and direct legal strategy as needed.
• Maintain clear, timely communication with claimants, providers, vendors, clients, and internal teams.
• Establish and manage claim reserves within guidelines and higher authority limits.
• Negotiate, settle, and finalize claims with appropriate settlement authority.
• Document files thoroughly; diary systems for timely review; identify injury trends.
• Collaborate with loss control staff to address risk management opportunities.
• Conduct independent file reviews to ensure quality and compliance.

Skills

Analytical skills

Written & verbal communication

Regulatory knowledge

Collaboration & stakeholder management

Microsoft Word

Microsoft Excel

Education

Bachelor’s degree in a related field

Tools

Microsoft Word

Microsoft Excel

Job description

TEEMA Group is seeking a senior Claims Examiner II/III to manage the full lifecycle of workers’ compensation indemnity claims in a challenging, autonomous role.

You will handle highly complex cases, ensure regulatory compliance, and collaborate with clients, claimants, vendors, and legal counsel. This remote-ready position requires strong analytical judgment and advanced communication skills to drive timely resolution.