Sr. Claims Examiner

Seneca Resources Company, LLC; Virginia (MN); Hybrid; USD 48,216 - 61,992; Full time

Benefits offered by this job

Competitive pay

Comprehensive health coverage

401(k) retirement plans

Support from a dedicated team

Job summary

A leading staffing and consulting firm is seeking an experienced Senior Claims Examiner to manage complex Workers’ Compensation claims within a dynamic healthcare environment. This role is crucial in ensuring timely claims resolution while collaborating with various stakeholders. Ideal candidates will have a minimum of 7 years of experience in Workers’ Compensation, strong negotiation and investigation skills, and the ability to handle high-complexity claims. This position is hybrid, requiring onsite presence 1-2 days a week.

Qualifications

• Minimum 7 years of Workers’ Compensation claims experience.
• In-depth knowledge of Virginia Workers’ Compensation laws.
• Ability to manage high-complexity claims independently.
• Experience with medical management and return-to-work coordination.

Responsibilities

• Manage Workers’ Compensation claims from low to high complexity.
• Ensure compliance with the Virginia Workers’ Compensation Act.
• Negotiate settlements and manage subrogation efforts.
• Coordinate with medical providers to support return-to-work programs.

Skills

Workers’ Compensation claims adjudication

Negotiation skills

Analytical skills

Investigation skills

Communication skills

Medical management

Proficiency in Microsoft Office

Education

High School Diploma or GED

Associate’s or Bachelor’s degree in Business or Finance

Job description

Senior Claims Examiner – Workers’ Compensation

Location: Richmond, VA (Hybrid – 1–2 days onsite)

Clearance Requirements: U.S. Citizen or Green Card Holder

Position Status: Contract (4 months with potential extension or conversion)

Pay Rate: $35–$45 per hour

We are seeking an experienced Senior Claims Examiner to manage complex Workers’ Compensation claims within a dynamic, fast‑paced healthcare environment. This role plays a critical part in ensuring compliant, timely, and equitable claims resolution while partnering closely with internal stakeholders, medical providers, and external vendors.

The ideal candidate is a detail‑oriented claims professional with deep knowledge of Virginia Workers’ Compensation law, strong investigative and negotiation skills, and the ability to manage high‑dollar, high‑complexity claims from intake through resolution. This hybrid role offers flexibility while maintaining strong collaboration with on‑site teams.

Key Responsibilities

• Investigate, evaluate, and manage Workers’ Compensation claims from low to high complexity, including catastrophic and litigated cases exceeding $2M in total exposure.
• Ensure compliance with the Virginia Workers’ Compensation Act, including timely filing of FROIs and SROIs.
• Determine compensability, establish reserves, and authorize medical and indemnity payments within delegated authority.
• Conduct investigations, gather evidence, interview witnesses, and document findings thoroughly.
• Coordinate medical management, review medical records, and collaborate with treating providers to support return‑to‑work and transitional duty programs.
• Manage litigation activities, including working with counsel, attending hearings, depositions, and providing testimony as needed.
• Serve as a key liaison among injured employees, supervisors, HR, payroll, employee health, safety teams, and external partners.
• Negotiate settlements, manage subrogation efforts, and oversee vendor performance (adjusters, medical, vocational, investigative).
• Identify trends and partner with safety and injury prevention teams to reduce workplace risk.
• Support additional claims activities such as bill review negotiations, OSHA reporting, risk assessments, and insurance renewal support.
• Demonstrate accountability, professionalism, and commitment to safety, equity, and high‑reliability practices.

Required Skills / Education

• Minimum 7 years of progressively responsible Workers’ Compensation claims adjudication or equivalent experience.
• In‑depth knowledge of Virginia Workers’ Compensation laws and procedures.
• Proven ability to manage high‑complexity and litigated claims independently.
• Strong investigation, negotiation, analytical, and decision‑making skills.
• Experience with medical management and return‑to‑work coordination.
• Proficiency with Microsoft Office (Word, Excel, Outlook).
• Ability to manage multiple priorities, work independently, and adapt in a fast‑changing environment.
• Excellent written, verbal, and interpersonal communication skills.
• High School Diploma or GED required.

Preferred Skills & Experience

• Experience handling general liability, auto liability, or property & casualty claims.
• Prior lead, senior, or supervisory claims experience.
• Background in risk management, healthcare, or legal environments.
• Associate’s or Bachelor’s degree in Business, Finance, or a related field.

About Seneca Resources

At Seneca Resources, we are more than just a staffing and consulting firm — we are a trusted career partner. With offices across the U.S. and clients ranging from Fortune 500 companies to government organizations, we provide opportunities that help professionals grow their careers while making an impact.

When you work with Seneca, you’re choosing a company that invests in your success, celebrates your achievements, and connects you to meaningful work with leading organizations nationwide. We take the time to understand your goals and match you with roles that align with your skills and career path. Our consultants and contractors enjoy competitive pay, comprehensive health, dental, and vision coverage, 401(k) retirement plans, and the support of a dedicated team who will advocate for you every step of the way.

Seneca Resources is proud to be an Equal Opportunity Employer, committed to fostering a diverse and inclusive workplace where all qualified individuals are encouraged to apply.