Workers’ Compensation Claims Examiner III - Hybrid

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.

• No adjuster’s license required.