Workers’ Compensation Claims Examiner III - Hybrid

TEEMA; Albuquerque (NM); Hybrid; USD 80,000 - 90,000; Full time

Job summary

TEEMA Solutions Group seeks a Workers’ Compensation Claims Examiner III in Albuquerque with 2+ years of claims experience and strong knowledge of New Mexico statutes. The role involves an active caseload and independent judgment on compensability decisions, with a path to hybrid work after training.

Responsibilities include managing medical treatment and billing, setting reserves, and maintaining meticulous file documentation while coordinating with claimants, providers, and clients.

Qualifications

• 2+ years of Workers’ Compensation claims experience.
• Working knowledge of New Mexico Workers’ Compensation statutes and benefit administration.
• Ability to manage an active caseload independently and apply strong judgment to compensability decisions.
• Excellent analytical, written, verbal, and customer-service skills.
• Microsoft Word and Excel proficiency preferred.

Responsibilities

• Investigate claims, determine compensability, and administer benefits in accordance with New Mexico law and company guidelines.
• Manage medical treatment, authorizations, and medical billing.
• Establish and maintain appropriate reserves within assigned authority.
• Maintain accurate, timely file documentation and diary activity.
• Communicate clearly with claimants, medical providers, vendors, clients, and internal partners.
• Identify and report injury trends or safety-related concerns to clients.
• Participate in client file reviews and handle claims in other jurisdictions as assigned.

Skills

Analytical

Communication

Judgment

Customer Service

Education

High school diploma or GED

Bachelor’s degree preferred

Tools

Microsoft Word

Excel

Job description

Workers’ Compensation Claims Examiner III
Albuquerquealbuquerque NM(Hybrid-2 days onsite after 2-3 weeks of training) | Direct Hire
$80,000-$90,000

Take ownership of a full Workers’ Compensation claims desk with a well-established third-party administrator. This role is ideal for an experienced examiner with strong New Mexico Workers’ Compensation knowledge who can independently manage files, make sound compensability decisions, and move claims efficiently from first report through resolution.

You will manage an active caseload of approximately 150 claims, including medical-only, indemnity, lifetime medical, and permanent partial benefit files. The position offers a hybrid schedule after initial onsite training.

Responsibilities include:

• Investigate claims, determine compensability, and administer benefits in accordance with New Mexico law and company guidelines.
• Manage medical treatment, authorizations, and medical billing.
• Establish and maintain appropriate reserves within assigned authority.
• Maintain accurate, timely file documentation and diary activity.
• Communicate clearly with claimants, medical providers, vendors, clients, and internal partners.
• Identify and report injury trends or safety-related concerns to clients.
• Participate in client file reviews and handle claims in other jurisdictions as assigned.

Qualifications:

• 2+ years of Workers’ Compensation claims experience required.
• Working knowledge of New Mexico Workers’ Compensation statutes and benefit administration.
• Ability to manage an active caseload independently and apply strong judgment to compensability decisions.
• Excellent analytical, written, verbal, and customer-service skills.
• High school diploma or GED required; bachelor’s degree preferred.
• Microsoft Word and Excel proficiency preferred.