Senior Claims Examiner (Workers' Compensation)

Position Summary

We are seeking an experienced Senior Claims Examiner to manage complex workers' compensation claims through the full claim lifecycle. This role requires strong analytical, investigative, and decision-making skills to evaluate coverage, manage litigation activities, establish reserves, negotiate settlements, and ensure timely claim resolution. The ideal candidate will thrive in a fast-paced environment and be comfortable handling complex claims independently while collaborating with legal counsel, clients, and other stakeholders.

Key Responsibilities

• Investigate, evaluate, and manage complex workers' compensation claims from inception through resolution.
• Interpret policy provisions and determine coverage applicability using sound judgment and industry expertise.
• Oversee all aspects of claim investigations, including gathering evidence, reviewing documentation, and evaluating liability and exposure.
• Develop and direct litigation strategies in partnership with legal counsel.
• Establish and maintain appropriate claim reserves and authorize payments within designated authority levels.
• Negotiate and settle claims in a timely, fair, and cost-effective manner.
• Issue claim payments and ensure proper documentation and compliance with applicable regulations and company procedures.
• Identify and pursue subrogation and third-party recovery opportunities.
• Analyze claim activity and prepare reports for clients, carriers, and management.
• Participate in claim reviews and provide recommendations regarding claim strategy and resolution.
• Maintain accurate claim documentation and ensure timely communication with all interested parties.

Required Qualifications

• Bachelor's degree or equivalent combination of education and relevant experience.
• 4-8 years of claims handling, claims investigation, or claims settlement experience.
• Workers' Compensation Adjuster License required based on applicable jurisdictional requirements.
• Strong understanding of workers' compensation claims processes, regulations, and industry best practices.
• Proven ability to independently manage complex claims and make sound coverage and settlement decisions.
• Excellent written and verbal communication skills.
• Strong negotiation and presentation abilities.
• Advanced analytical, problem-solving, and decision-making skills.
• Ability to manage multiple priorities and deadlines in a fast-paced environment.

Preferred Qualifications

• Professional industry designations such as:
  • Associate in Claims (AIC)
  • Associate in Claims Law (AEI)
  • Insurance Institute of America (IIA)
  • Chartered Property Casualty Underwriter (CPCU)
• Experience handling highly complex or litigated workers' compensation claims.
• Demonstrated expertise in reserve management, settlement strategy, and claim cost containment.

Key Competencies

• Claims Investigation & Resolution
• Workers' Compensation Claims Management
• Litigation Management
• Coverage Analysis
• Reserve Analysis
• Negotiation & Settlement
• Risk Assessment
• Subrogation Recovery
• Client Relationship Management
• Regulatory Compliance
• Written & Verbal Communication
• Problem Solving & Critical Thinking