Workers’ Compensation Claims Examiner III

Workers’ Compensation Claims Examiner III

Philadelphia, PA (Hybrid—2 days onsite) | Direct Hire - 19107
$85,000–$95,000

Join a growing claims team in a senior-level role managing complex Workers’ Compensation claims for multiple clients. This is an excellent opportunity for an experienced examiner who enjoys owning files from initial investigation through resolution while working collaboratively with clients, claimants, medical providers, and defense counsel.

You will manage a caseload of approximately 125–150 Workers’ Compensation claims, primarily in New Jersey with some Pennsylvania exposure. The role requires sound judgment, strong technical knowledge, and the ability to independently move complex files forward efficiently.

Responsibilities include:

• Investigate claims, determine compensability, and administer benefits in accordance with applicable state law.

• Manage medical treatment, billing, reserves, and claim documentation.

• Coordinate with claimants, providers, vendors, clients, and outside defense counsel.

• Evaluate exposure, negotiate settlements, obtain appropriate authority, and bring claims to resolution.

• Maintain accurate diary activity and thorough file notes.

• Conduct independent file reviews and communicate injury trends or safety concerns to clients.

• Partner with loss control resources when appropriate.

Qualifications:

• 3+ years of New Jersey Workers’ Compensation claims-handling experience required.

• Pennsylvania Workers’ Compensation experience preferred.

• Ability to independently manage complex indemnity claims.

• Strong knowledge of Workers’ Compensation regulations and medical terminology.

• Excellent analytical, written, verbal, and client-service skills.

• Bachelor’s degree preferred; equivalent experience considered.

• Adjuster’s license not required.