Workers Compensation Claims Examiner III

TEEMA; United States; Hybrid; USD 85,000 - 95,000; Full time

Benefits offered by this job

Financially stable organization

Competitive salary

Career growth opportunities

Ethical company culture

Job summary

A leading claims administration organization is looking for a Workers’ Compensation Claims Examiner III responsible for managing complex claims within Pennsylvania and New Jersey. The ideal candidate should have 3-5 years of experience, particularly handling indemnity and complex claims, with strong communication skills. This mid-senior level role offers a competitive salary, a people-first culture, and long-term career growth opportunities, making it an attractive position for experienced professionals in the insurance sector.

Qualifications

• 3-5+ years of workers’ compensation claims experience required.
• Experience handling both PA and NJ claims is essential.
• Strong knowledge of medical terminology and statutory regulations.

Responsibilities

• Manage 125-150 workers’ compensation claims.
• Investigate claims and determine compensability per laws.
• Communicate with claimants, medical providers, and stakeholders.

Skills

Workers’ compensation claims experience

Communication skills

Independence

Regulatory knowledge

Claims systems proficiency

Tools

Microsoft Word

Microsoft Excel

Job description

Base pay range

$85,000.00/yr - $95,000.00/yr

Location: Philadelphia, PA (Hybrid or In-Office)

Employment Type: Full-Time | Direct Hire

About the Opportunity

We’ve partnered with a well-established, nationally recognized third‑party claims administration organization within the insurance and risk management industry. This organization has been in operation for decades and supports clients across workers’ compensation, property & casualty, benefits administration, and managed care services.

They are known for their financial stability, ethical leadership, and employee‑first culture, offering long‑term career growth rather than short‑term churn. This role is part of an expanding claims operation and has strong visibility within the organization.

Position Overview

The Workers’ Compensation Claims Examiner III is responsible for managing the full lifecycle of indemnity workers’ compensation claims for Pennsylvania and New Jersey jurisdictions. This role handles a complex caseload and requires strong technical knowledge, independent judgment, and excellent communication skills.

This is an ideal opportunity for an experienced examiner who wants:

• Stability
• Competitive compensation
• Complex claims exposure
• A respected employer with national reach

Key Responsibilities

• Manage 125–150 workers’ compensation claims, including high‑complexity cases
• Handle claims from initial reporting through resolution
• Investigate claims and determine compensability in accordance with PA & NJ state laws
• Administer benefits and manage medical treatment and billing
• Set and manage reserves within established authority
• Coordinate with and direct outside defense counsel when needed
• Communicate effectively with claimants, medical providers, vendors, and internal stakeholders
• Maintain accurate documentation and diary management
• Identify claim trends and elevate issues appropriately
• Adhere to company policies, procedures, and ethical standards

Required Qualifications

• 3–5+ years of workers’ compensation claims experience
• Hands‑on experience handling both PA and NJ claims (required)
• Experience managing indemnity and complex claims
• Strong working knowledge of statutory regulations and medical terminology
• Ability to work independently with minimal supervision
• Strong written and verbal communication skills
• Proficiency with claims systems and Microsoft Word/Excel
• Hybrid or in‑office schedule (preference for PA‑based candidates)
• Professional business‑casual environment
• Collaborative claims operation with experienced leadership

Why Apply?

• Financially strong, privately held organization
• Competitive salary with long‑term growth potential
• Complex claims exposure that builds career value
• Ethical, people‑first company culture
• High visibility role with stability and structure

Apply Now!

Qualified candidates with PA and NJ workers’ compensation experience are encouraged to apply. Applications will be reviewed quickly, and qualified candidates will be contacted promptly.

Seniority level

Mid‑Senior level

Employment type

Full-time

Job function

• Customer Service
• Industries: Insurance and Claims Adjusting, Actuarial Services