Workers’ Compensation Claims Examiner III – NJ/PA

TEEMA GROUP; Philadelphia (Philadelphia County); On-site; USD 85,000 - 95,000; Full time

Benefits offered by this job

Hybrid schedule – 2 days in office

Job summary

TEEMA Solutions Group seeks an experienced Workers’ Compensation Claims Examiner III to join a national claims organization in a hybrid Philadelphia, PA setting. You will independently manage complex indemnity NJ claims from initial report through resolution.

The role requires 3–5+ years of NJ WC claims handling, handling 125–150 indemnity claims, and applying expanded reserve/settlement authority. Competitive salary and minimal supervision offered.

Qualifications

• 3–5+ years of Workers’ Compensation claims handling experience.
• Strong New Jersey Workers’ Compensation claims experience required.
• Experience handling complex indemnity claims independently.
• Strong knowledge of New Jersey Workers’ Compensation statutes and regulations.
• Experience with compensability decisions, investigations, medical management, reserves, litigation, and settlements.

Responsibilities

• Manage approximately 125–150 Workers’ Compensation indemnity claims.
• Handle complex New Jersey Workers’ Compensation claims from initial report through resolution.
• Investigate claims and make compensability determinations.
• Administer benefits in accordance with state regulations and company guidelines.
• Review medical records, treatment requests, work status, and claim documentation.
• Authorize and coordinate appropriate medical treatment.
• Review and manage medical billing issues.
• Establish and adjust reserves based on claim exposure.
• Exercise expanded reserve and settlement authority appropriate to the Examiner III level.
• Develop claim strategies to drive timely and appropriate resolution.
• Refer claims to defense counsel and provide ongoing direction regarding litigation strategy.
• Review legal recommendations and monitor litigation developments.
• Negotiate settlements and obtain additional authority when necessary.
• Maintain accurate documentation and a disciplined diary system.
• Communicate with clients regarding claim status, exposure, reserves, and resolution strategies.
• Identify injury trends and potential safety concerns.
• Coordinate with loss-control resources when appropriate.
• Maintain compliance with applicable Workers’ Compensation statutes and regulations.

Skills

New Jersey workers’ comp experience

Claims handling experience

Indemnity claims

Investigations & compensability

Tools

Microsoft Word

Excel

Job description

Location: Philadelphia, PA – Hybrid
Salary: $85,000–$95,000/year
Schedule: Hybrid – 2 Days In Office
Employment Type: Direct Hire

Overview

We are seeking an experienced Workers’ Compensation Claims Examiner III to join an established national claims organization. This is a senior-level opportunity for someone with strong New Jersey Workers’ Compensation claims experience who can independently manage complex indemnity claims from initial investigation through resolution.

This position offers a hybrid schedule, competitive salary, expanded claims authority, and the opportunity to manage a diverse multi-client caseload with minimal supervision.

What You Will Be Doing

Manage approximately 125–150 Workers’ Compensation indemnity claims.

Handle complex New Jersey Workers’ Compensation claims from initial report through resolution.

Investigate claims and make compensability determinations.

Administer benefits in accordance with state regulations and company guidelines.

Review medical records, treatment requests, work status, and claim documentation.

Authorize and coordinate appropriate medical treatment.

Review and manage medical billing issues.

Establish and adjust reserves based on claim exposure.

Exercise expanded reserve and settlement authority appropriate to the Examiner III level.

Develop claim strategies to drive timely and appropriate resolution.

Refer claims to defense counsel and provide ongoing direction regarding litigation strategy.

Review legal recommendations and monitor litigation developments.

Negotiate settlements and obtain additional authority when necessary.

Maintain accurate documentation and a disciplined diary system.

Communicate with clients regarding claim status, exposure, reserves, and resolution strategies.

Identify injury trends and potential safety concerns.

Coordinate with loss-control resources when appropriate.

Maintain compliance with applicable Workers’ Compensation statutes and regulations.

What You Must Have

3–5+ years of Workers’ Compensation claims handling experience.

Strong New Jersey Workers’ Compensation claims experience required.

Experience handling complex indemnity claims independently.

Strong knowledge of New Jersey Workers’ Compensation statutes and regulations.

Experience with compensability decisions, investigations, medical management, reserves, litigation, and settlements.

Ability to independently establish and adjust reserves.

Strong knowledge of medical terminology.

Excellent written and verbal communication skills.

Strong organizational and caseload-management skills.

Preferred

Microsoft Word and Excel proficiency.

TPA or multi-client claims experience.

Why Join?

$85,000–$95,000 annual salary

Hybrid schedule – only 2 days per week in office

Senior-level reserve and settlement authority

Minimal supervision and greater autonomy

Established defense counsel and loss-control support

Diverse multi-client caseload

Long-term career opportunity with an established organization

No claims license is required for this position.