Sr Claim Examiner- WC

Hornet Staffing, Inc, a GEE Group company; Arizona; On-site; USD 70,000 - 90,000; Full time

Job summary

Hornet Staffing, Inc., a GEE Group company, seeks an experienced Claims Specialist to interpret complex policy coverages and manage investigations for workers' compensation claims. You will determine coverage applicability and direct discovery and litigation strategies alongside legal counsel.

The role requires 4–8 years in claims, a Bachelor's degree or equivalent, and a WC Adjuster License per jurisdiction, with strong analytical and communication skills.

Qualifications

• Bachelor's degree or equivalent experience required.
• Technical claims investigations/settling experience with 4–8 years in Claims.
• Workers' Compensation (WC) Adjuster License required per jurisdictional requirements.

Responsibilities

• Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.
• Manages all aspects of investigative activity on complex claims.
• Directs the discovery and litigation strategy with legal counsel.
• Analyzes claims activity and prepares reports for clients/carriers and management.
• Establishes reserves, uses independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.
• Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits.
• Develops subrogation and third party recovery potential and follows reclaim procedures.
• Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.

Skills

Independent judgment

Strong communication

Analytical skills

Education

Bachelor's degree or equivalent experience

4–8 years technical claims investigations/settling experience

WC Adjuster License

Job description

• Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.
• Manages all aspects of investigative activity on complex claims.
• Directs the discovery and litigation strategy with legal counsel.
• Analyzes claims activity and prepares reports for clients/carriers and management.
• Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.
• Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits.
• Develops subrogation and third party recovery potential and follows reclaim procedures.
• Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.

Skills:

• Ability to work independently while assimilating various technical subjects.
• Strong written and oral communication, negotiation and presentation skills.
• Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects.

Education:

• Bachelor's degree or equivalent experience.
• Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization.
• Workers Compensation (WC) Adjuster License required according to jurisdictional requirements.

Preferred:

• Industry designations such as IIA, AIC, AEI and/or CPCU

Client's Note:

Claims bachelor's degree or equivalent experience. - Technical claims investigations/settling experience with 4-8 years' experience in Claims or similar organization. Workers Compensation (WC) Adjuster License required according to jurisdictional requirements. Preferred: - Industry designations such as IIA, AIC, AEI and/or CPCU