Worker's compensation claims examiner jobs near me - 118 jobs

Workers' Compensation Claims Adjuster - Temp
Argonaut Management Services, Inc.
Worker's compensation claims examiner job in Columbus, OH
Argo Group International Holdings, Inc.and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. ("BWS"), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions. Job Description Business Title(s):Workers' Compensation Claims Adjuster Employment Type:Contingent Worker FLSA Status:Non-Exempt Location:In-Officeor Remote Summary: Although Rockwood underwrites general liability insurance and workers' compensation for many types of businesses, ourspecialtyis underwriting workers' compensation insurance for the mining industry, with a focus on the coal-mining industry. Rockwood has become a leading underwriter of workers' compensation for the mining industry by offering workers' compensation insurance with a commitment to providing the best service on loss control and claims, collaborating across all departments with this common goal. We have never been more committed to our clients to ensure their employees receive excellent medical care if they need it due to a work-related injury or illness. Our passion for outstanding customer focus, combined with our deep industry experience, is what sets up apart from other insurance carriers in this niche market. We are looking for a highly capable Workers' Compensation Claims Adjuster to help us on a temporary assignment through13February2026 and work from anywhere in the continental United States. If this assignment is filled in one of our following offices, the assignment can be considered temp-to-hire: Albany, Chicago, Los Angeles, New York,Omaha, Richmond (VA), Rockwood (PA), or Springfield (MO). This role will adjudicate indemnity workers' compensation claims of higher technical complexity for our customers in the states of IL, IN, KY, NY, PA, and VA. As this is a temporary assignment, only government-mandated benefits will be provided. Essential Responsibilities: Working under technical direction and within significant limits and authority,adjudicateworkers' compensation claims of higher technical complexity, with a direct impact on departmental results. Resolving issues that are generalized and typically notcomplex butrequire understanding of a broader set of issues. Reporting to senior management and underwriters onclaimstrends and developments. Investigating claims promptly and thoroughly. Analyzing claims forms, policies and endorsements, client instructions, and other records todeterminewhether the loss falls within the policy coverage. Investigating claims promptly and thoroughly, including interviewing all involved parties. Managing claims in litigation. Managing diarytimelyand complete tasks to ensure that cases move to the best financial outcome andtimelyresolution. Properly setting claim reserves. Identifying, assigning, and coordinating the assignment and coordination ofexpertiseresources toassistin case resolution. Preparing reports for file documentation. Applying creative solutions which result in the best financial outcome. Negotiating settlements. Completing telephone calls and written correspondence to/from various parties (insured, claimant, etc.). Having an appreciation and passion for strong claim management. Qualifications / Experience Required: A practical knowledge ofadjudicatingworkers' compensation claims through: A minimum of two years' experienceadjudicatingindemnity workers' compensation claims in one or more of the following jurisdictions: IL, IN, KY, NY, PA, and/or VA. Bachelor'sdegree from an accredited universityrequired. Two or more insurance designations or fouradditionalyears of related experienceadjudicatingindemnity claims beyond the minimum experiencerequiredabove may be substituted in lieu of a degree. Must be licensed in KYand NY Must have good business acumen (i.e.understand how an insurance company works and makes money, including how this role impacts both Argo Group and our customers' ability to be profitable). A practical knowledge ofadjudicatingworkers' compensation claims through: Must have excellent communication skills and the ability to build lasting relationships. Exhibit natural curiosity Desireto work in a fast-paced environment. Excellent evaluation and strategic skillsrequired. Strong claim negotiation skillsa must. Mustpossessa strong customer focus. Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines. Ability to articulate the financial value of your work at multiple responsibility levels inside our clients' business which may include CEO. Must work independently anddemonstratethe ability to exercise sound judgment. Demonstrates inner strength. Has the courage to do the right thing anddemonstratesit on a daily basis. Intellectual curiosity. Consistently considers all options and is not governed by conventional thinking. Proficient in MS Office Suite and other business-related software. Polished and professional written and verbal communication skills. The ability to read and write English fluently isrequired. Mustdemonstratea desire for continued professional development through continuing education and self-development opportunities. The base salary range provided below is for hires in those geographic areas only and will becommensuratewith candidate experience. Pay ranges for candidates in other locations may differ based on the cost of labor in that location. In addition to base salary, all employees are eligible for an annual bonus based on company and individual performance as well as a generous benefits package. Colorado outside of Denver metro, Maryland, Nevada, and Rhode Island Pay Ranges:$37.66- $44.33per hour California outside of Los Angeles and San Francisco metro area, Connecticut, Chicago metro area, Denver metro area, Houston metro area, New York State (including Westchester County)and Washington State Pay Ranges:$41.44- $48.79per hour Los Angeles, New York City and San Francisco metro areas Pay Ranges:$45.12- $53.16per hour About Working in Claims at Argo Group Argo Group does not treat our claims or our claims professionals as a commodity. The work we offer is challenging, diverse, and impactful. Our Adjusters and Managers are empowered to exercise their independent discretion and, within broad limits and authority, be creative in developing solutions andtreateach case as the unique situation it is. We have a very flat organizational structure, enabling our employeeshavemore interaction with our senior management team, especially when it relates to reviewing large losses. Our entire claims team works in a collaborative nature to expeditiously resolve claims.We offer a work environment that inspires innovation and is open to employee suggestions. We even offer rewards for creative and innovative ideas. We believe in building an inclusive and diverse team, and we strive to make our office a welcoming space for everyone. We encourage talented people from all backgrounds to apply. PLEASE NOTE: Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas. If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at . Notice to Recruitment Agencies: Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and / or its affiliates will not be responsible for any fees associated with unsolicited submissions. We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical) , including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, child birth, breastfeeding, and medical conditions related to pregnancy, child birth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics. The collection of your personal information is subject to our HR Privacy Notice Benefits and Compensation We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program-including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.
$37.7-44.3 hourly 5d ago

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Senior Workers Compensation Examiner (Iowa)
Canon Recruiting Group 3.3
Remote worker's compensation claims examiner job
Workers' Compensation Claims Examiner - Iowa (Single-Jurisdiction) Employment Type: Direct Hire Work Arrangement: Fully Remote We are seeking an experienced Workers' Compensation Claims Examiner to manage a single-jurisdiction Iowa workers' compensation desk. This role is responsible for end-to-end claims handling, including investigation, compensability decisions, medical management, litigation oversight, and resolution. The ideal candidate has strong knowledge of Iowa workers' compensation statutes, rules, timelines, and best practices, along with excellent communication and customer-service skills. This is a direct-hire, fully remote position offering long-term stability and significant autonomy. Key Responsibilities Maintain detailed, timely claim file documentation to meet compliance and audit standards. Ensure adherence to Iowa statutory timelines and reporting requirements. Negotiate settlements within authority and recommend settlements above authority as needed. Collaborate with internal teams on risk reduction, claim strategy, and best practices. Required Qualifications 2-5+ years of workers' compensation claims handling experience (Iowa experience required). Strong knowledge of Iowa workers' compensation statutes and administrative rules. Demonstrated ability to manage a full claim inventory independently. Experience handling litigated claims and working with defense counsel. Proficiency with claims management systems and standard office software. Excellent verbal and written communication skills. Strong analytical, organizational, and time-management abilities. Ability to succeed in a fully remote, self-directed environment. Preferred Qualifications Multi-state experience (optional but beneficial). Industry certifications (e.g., AIC, WCCP, WCP, SCLA). Experience with return-to-work programs and medical management strategies. Compensation & Benefits Competitive salary (DOE). Comprehensive benefits package (medical, dental, vision, 401(k), etc.). Paid time off and company holidays. Remote work equipment support (if applicable). Opportunities for professional development and certification support. Here at Canon Recruiting, People are our priority, and we are committed to Include Diversity in every segment of who we are. It is only through our Diversity; we are made a stronger organization and increase our ability to provide top tier candidates that our clients have come to know Canon for. We have an inclusive environment all employees are celebrated for their unique differences. The different perspectives and experiences of our workforce give us the competitive advantage that is essential for success in an ever-changing market. By promoting inclusion with the same enthusiasm, we devote to quality and competency and using the experience from a diverse assortment of backgrounds and experiences, Canon can improve the services and value we deliver to clients, employees, and customers. At Canon, Diversification and Inclusiveness are much more than a corporate ambition; they are a critical component in our daily corporate life. Canon Recruiting is committed to a diverse and inclusive workplace. Canon Recruiting is an equal opportunity employer and does not discriminate based on race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status. The pay range for this position is listed above. Base pay information is based on market location. We will consider for employment qualified applicants with arrest and conviction records. Our range of benefits may include health care and 401(k) savings plans. For individuals with disabilities who would like to request an accommodation, please email hr@canonrecruiting.com
$41k-66k yearly est. 35d ago
Workers Compensation Claims Examiner
Suretyhr
Worker's compensation claims examiner job in Columbus, OH
Spooner Incorporated is a family owned and operated company that offers rewarding career opportunities for motivated individuals who are passionate about excellence and growth. Since 1975, Spooner's proactive philosophy and best practices have set the standard in workers' compensation, preventing excessive compensation and medical costs in claims while assisting employees in early, healthy return to work. The Workers Compensation Claims Examiner is primarily responsible for analyzing and processing complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim. Essential Functions · Report, investigate, manage, and resolve workers' compensation claims for assigned state(s). · Assists the Claims Manager in identifying claim trends and developing safety recommendations to mitigate the company's overall cost of risk. · Support the Risk Management department on risk-related projects. · Gather data for resolving claims. · Coordinate with medical/special investigators and vendor partners to reduce overall claims. · Manage the litigation process to ensure timely and effective claims resolution. · Participate in continuous improvement activities and other assigned duties. Supervision Received · Reports to the Claims Manager Experience and Education Required · Associates Degree from an accredited college or university · One (1) year of working in the claim's environment · Excellent communication and organization skills. · Strong computer skills with working knowledge of Word, Excel, PowerPoint, Outlook. · Ability to travel for work. Experience and Education Preferred · Bachelor's degree from an accredited college or university · Knowledge of medical terminology · Detail oriented · Self-motivated, accepts responsibility, and enjoys a challenge · Determined and focused on accomplishing tasks in a timely fashion · Strong interpersonal and communication skills Tools and Equipment Used The occupant is expected to freely operate the following tools and equipment: personal computer (including word processing, spreadsheet, and database programs); printer; calculator; telephone; copier; fax machine. Working Environment The work environment characteristics described herein are representative of those an employee encounters while performing the essential functions of the job. While performing the duties of this job, the employee typically works in a normal office environment. The noise level in the work environment is usually quiet. Physical Demands The physical demands described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to use hands to finger, handle, carry or operate objects, tools or controls and reach with hands and arms. The employee frequently is required to stand; talk or hear; walk, sit. Specific vision abilities required by this job include close vision and the ability to adjust focus.
$38k-65k yearly est. Auto-Apply 60d+ ago
Workers Compensation Claim Adjuster
Davies 4.0
Remote worker's compensation claims examiner job
Department Claims Administration & Adjusting Employment Type Permanent - Full Time Location Home United States Workplace type Fully remote Compensation $60,000 - $70,000 / year Reporting To Nicole Stephens Key Responsibilities Skills, knowledge & expertise Benefits About Davies We are a specialist professional services and technology firm, working in partnership with leading insurance, highly regulated and global businesses. We help our clients to manage risk, operate their core business processes, transform and grow. We deliver professional services and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation & risk, customer experience, human capital, digital transformation & change management. Our global team of more than 8,000 professionals operate across ten countries, including the UK & the U.S. Over the past ten years Davies has grown its annual revenues more than 20-fold, investing heavily in research & development, innovation & automation, colleague development, and client service. Today the group serves more than 1,500 insurance, financial services, public sector, and other highly regulated clients.
$60k-70k yearly 60d+ ago
Workers' Compensation Claims Adjuster
Integrion Group
Remote worker's compensation claims examiner job
Job Title: Workers' Compensation Claims Adjuster Department: Workers' Compensation Reports to: Claim Operations Manager This is an office position responsible for the adjudication of workers' compensation claims, assigned by our clientele, in accordance with the Arizona and Colorado Workers' Compensation Statutes, governing rules and regulations, related case law and client and company procedures. New loss assignments are account driven, based on case complexity and experience levels of the adjuster. Fully remote work for applicants located outside of the Albuquerque area. Essential Functions: Investigate new claims to verify claim information including but not limited to: injury/accident history and determination of compensability. This includes 3 point contact, interviewing employer, employees, witnesses; taking recorded statements; coordination of medical treatment and identifying subrogation opportunities. Demonstrate the ability to complete claim documentation in company CMS and/or other client proprietary computer claim systems utilized. This position is responsible for reporting to clients per their specific guidelines. Must be familiar with a diary system and keep all open files maintained on that diary. Strong analytical skills for proper posting and monitoring of reserves for medical, indemnity and expense lines pursuant to client instructions and or company best practice standards. Timely review and payment of medical bills and issuance of indemnity benefits per Statutory requirements. Must demonstrate proficiency in the application of state statutes, related case law and the ability to interpret and comply with client and company standards, policies and procedures. This position is responsible for making required legal filings; state filings through EDI. Ensure that proper outside vendors referrals are made and properly justified. Attend legal proceedings, mediations and hearings. Represent the client and company at trail. Address return to work issues and strategies to mitigate lost time exposures. Evaluate medical records / reports and calculate impairment and modifiers benefits as applicable. Identify strategies for claim settlements. Job Qualifications: Education: High school diploma required. Bachelor's degree from an accredited college or university preferred. Experience: A minimum of five years workers' compensation claims experience working with an insurance company or third-party administrator. Additional relevant experience considered in lieu of education. Required Skills/Abilities: Demonstrate expertise investigating, evaluating and negotiating workers' compensation claims required. Demonstrate advanced knowledge of complex medical issues. Possess outstanding customer service and conflict resolution skills. Strong presentation and negotiation skills. Attention to detail and accuracy. Excellent oral and written communication skills. Ability to build and maintain relationships with internal and external stakeholders. Technologically savvy, able to navigate current computer system; proprietary client systems and internet programs with speed and efficiency. Excellent organization skills which includes ability to multi-task and prioritize. Must be a self-starter with the ability to work independently and as part of a team. Specialized Knowledge, Licenses, etc.: Demonstrated proficiency in: Professional designations, such as AIC, ARM, CPCU (Preferred but not required) Ability to obtain Arizona Workers' Compensation Adjuster License (Required) MS Word and Outlook (Required) MS Excel and PowerPoint (Preferred) Adobe (Preferred) Values and Mission: Adhere to values and mission by demonstrating Service Excellence, Trust, Ownership, One team and Boldness in thought and action. Positive Attitude: Develops and maintains positive working relationships with team members, customers, co-workers and management by demonstrating effective communication and collaborative skills. Working Conditions: Integrion Group maintains general office conditions with light physical demands. Employees of Integrion Group adhere to all safety rules and regulations including building security. Employees participate in ensuring safe and efficient operating conditions that safeguard employees and facilities. Integrion Group maintains a drug free environment; drug testing prior to employment as well as upon a work related accident Exposure to VDT screens.
$45k-59k yearly est. 40d ago
(Remote) Senior Claims Examiner
Efinancial 4.7
Remote worker's compensation claims examiner job
The Senior Claims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Senior Claims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines. Key Responsibilities: * Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person. * Review newly reported claims and log them on the pending claims log. * Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions. * Review and interpret insurance policy provisions to ensure accurate and timely claim decisions. * Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed. * On claims within the Senior Claims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly. * Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed. * Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed. * Handle and log specific State and NAIC policy locator searches. * Mentor and support third-party claims administration staff. * Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise. * Work on special projects and other duties as assigned by the Claims Manager. * Perform quarterly claim audits focusing on third-party claim handling. * Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams. * Handle Department of Insurance claim complaints or requests in a timely and professional manner. * Stay current on all laws, regulations, and industry updates that impact claim handling and compliance * Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests. * Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights * Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact * Support M&A activity, if applicable Qualifications: * 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred). Skills: * Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements. * Ability to meet deadlines while performing multiple functions. * Proficient in MS Office applications and the Internet. * Ability to proactively analyze and resolve problems. * Attention to detail. * Flexibility and willingness to adapt to changing responsibilities. * Excellent written communication, interpersonal and verbal skills. * Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages. * Proactive and outside-the-box thinker. * Independent and organized work style. * Ability to maintain strong performance while working remotely and independently, if applicable. * Strong judgment and discretion when handling highly confidential business, employee, and customer information. * Team player and creative, critical thinker highly desired. Licenses + Certifications: * Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required. * Legal or Paralegal Certifications optional but useful Essential Functions: * This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time. * Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential. * Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence. * Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays. * When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers. * Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role. Compensation & Benefits: We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide: * Salary Range: $70,720 - $91,520 * Medical Insurance: Choose from a variety of plans to fit your healthcare needs. * Dental Insurance: Coverage for preventive, basic, and major dental services. * Employer-Paid Vision: Comprehensive eye care coverage at no cost to you. * Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection. * Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury. * 401(k) Plan: Save for your future with a company match to help you grow your retirement savings. * PTO and Sick Time accrue each pay period: Take time off when you need it * Annual Bonus Program: Performance-based bonus to reward your hard work. EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages. Remote work is not available in the following States: California, Colorado, Connecticut, and New York. #FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
$70.7k-91.5k yearly 39d ago
(Remote) Senior Claims Examiner
Your Journey Starts Here
Remote worker's compensation claims examiner job
The Senior Claims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Senior Claims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines. Key Responsibilities: Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person. Review newly reported claims and log them on the pending claims log. Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions. Review and interpret insurance policy provisions to ensure accurate and timely claim decisions. Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed. On claims within the Senior Claims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly. Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed. Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed. Handle and log specific State and NAIC policy locator searches. Mentor and support third-party claims administration staff. Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise. Work on special projects and other duties as assigned by the Claims Manager. Perform quarterly claim audits focusing on third-party claim handling. Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams. Handle Department of Insurance claim complaints or requests in a timely and professional manner. Stay current on all laws, regulations, and industry updates that impact claim handling and compliance Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests. Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact Support M&A activity, if applicable Qualifications: 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred). Skills: Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements. Ability to meet deadlines while performing multiple functions. Proficient in MS Office applications and the Internet. Ability to proactively analyze and resolve problems. Attention to detail. Flexibility and willingness to adapt to changing responsibilities. Excellent written communication, interpersonal and verbal skills. Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages. Proactive and outside-the-box thinker. Independent and organized work style. Ability to maintain strong performance while working remotely and independently, if applicable. Strong judgment and discretion when handling highly confidential business, employee, and customer information. Team player and creative, critical thinker highly desired. Licenses + Certifications: Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required. Legal or Paralegal Certifications optional but useful Essential Functions: This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time. Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential. Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence. Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays. When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role. Compensation & Benefits: We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide: Salary Range: $70,720 - $91,520 Medical Insurance: Choose from a variety of plans to fit your healthcare needs. Dental Insurance: Coverage for preventive, basic, and major dental services. Employer-Paid Vision: Comprehensive eye care coverage at no cost to you. Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection. Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury. 401(k) Plan: Save for your future with a company match to help you grow your retirement savings. PTO and Sick Time accrue each pay period: Take time off when you need it Annual Bonus Program: Performance-based bonus to reward your hard work. EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages. Remote work is not available in the following States: California, Colorado, Connecticut, and New York. #FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
$70.7k-91.5k yearly 37d ago
Senior Claims Examiner (remote)
Switch'd
Remote worker's compensation claims examiner job
*5 years WC experience combined in WC *Remote (Must live in CA) *California License SIP not needed but is a plus *4850 (if not can train) *Bilingual (Not necessarty but a plus) $80-$94k
$80k-94k yearly 60d+ ago
Sr Field Claims Specialist
BP&C
Remote worker's compensation claims examiner job
Argo Group International Holdings, Inc. and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. (“BWS”), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions. Job Description PURPOSE OF THE JOB: The position assumes responsibility for handling property claims including high severity and complex losses within a specified territory. ESSENTIAL FUNCTIONS: Inspects the damage of the loss. Determines the investigative needs to assess damages, the cause of the loss, and the coverage. Interviews the claimants and witnesses. Conducts additional research or identifies additional investigation needs and resources, as needed. Identifies potential fraud indicators. Assesses the salvage/subrogation potential and monitors to them to the conclusion. Completes the risk evaluation for underwriting and claims purposes. Verifies and interprets the policy coverage, deductibles, and liability; and analyzes what may be covered. Reviews and documents the facts of the loss and estimates the cost of the repairs and/or replacements including detailed diagrams, reports and estimates. Communicates and explains the process, estimates, etc., to the policyholder. Negotiates with the insured, contractors, and vendors, as needed. Maintains contact with claimants, agents, and attorneys, regarding the ongoing status of claims files. QUALIFICATIONS: High school diploma. Five or more years of experience in insurance, construction or related field State license and/or ability to obtain one. SPECIAL POSITION REQUIREMENTS: The position involves considerable physical exertion, such as regular climbing of ladders, lifting of heavy objects (up to 80 pounds) on a highly frequent basis and/or assuming awkward positions for long periods of time. A person in this position is expected to make independent decisions in accordance with the company's policies and procedures. Full time remote position Travel required. PREFERENCES: Bachelor's Degree Property Claims Handling Experience ideally including Commercial, Farm and Ranch experience Field adjusting and estimating knowledge. Insurance designations such as Chartered Property Casualty Underwriter (CPCU), Associate in Claims (AIC) or Senior Claim Law Associate (SCLA). Salary range is $68100 - $125000 PLEASE NOTE: Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas. If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at ************. Notice to Recruitment Agencies: Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and / or its affiliates will not be responsible for any fees associated with unsolicited submissions. We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical) , including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, child birth, breastfeeding, and medical conditions related to pregnancy, child birth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics. The collection of your personal information is subject to our HR Privacy Notice Benefits and Compensation We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program-including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.
$68.1k-125k yearly Auto-Apply 8d ago
Technical Claims Spec, Workers Compensation
Liberty Mutual 4.5
Remote worker's compensation claims examiner job
Under limited supervision and established practices, responsible for the investigation, evaluation, and disposition of Complex Workers Compensation cases of high exposure and severity. Applies established medical management strategies on high dollar complex claims. Has developed high level knowledge of Workers Compensation claims handling techniques, a full knowledge of LMG claims procedures and is cognizant of new industry trends and claim handling techniques Uses available data to track claims trends and other claim related metrics. This is a remote position. Candidates residing within 50 miles of Weatogue, CT office are required to report onsite twice a month. Please note this policy is subject to change. Responsibilities: Investigates claims to determine whether coverage is provided, establish compensability and verify exposure. Resolves claims within authority and makes recommendations regarding case value and resolution strategy to Branch Office Management and HO Examining on cases which exceed authority. Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management. Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols. Identifies and appropriately handles suspicious claims and claims with the potential to develop adversely. Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure. Establishes and maintains accurate reserves on all assigned files. Makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority. Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insureds. Demonstrates the ability to understand new and unique exposures and coverages. Demonstrates the ability to understand key data elements and claims related data analysis. Confers directly with policyholders on coverage and resolution strategy issues. Coordinates and participates in training sessions for less experienced staff, including both Complex non-Complex staff. Qualifications A Bachelors degree or equivalent business experience is required. In addition, the candidate will generally posses 5-7 years of related claims experience with 1-2 years of experience in complex claims. Demonstrated proficiency in Excel, PowerPoint as well as excellent written and verbal. communication skill required. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco
$57k-69k yearly est. Auto-Apply 26d ago
Workers' Compensation Claims Adjuster - REMOTE
Aegis Security Insurance 4.2
Remote worker's compensation claims examiner job
Midwestern Insurance Alliance (MIA) is seeking a full-time Remote Claims Adjuster to join its worker's compensation claims processing team. MIA is a national workers' compensation program administrator offering custom-tailored worker's compensation insurance programs through its carrier partners. MIA focuses on niche segments such as local and long-haul trucking, parcel and mail delivery, and fuel hauling. MIA's acquisition by San Diego-based K2 Insurance Services in 2012 has enabled MIA to expand its product offerings and product distribution channels. Claims Adjuster responsibilities include, but are not limited to: Thoroughly investigating worker's compensation claims by contacting injured workers, medical providers, and employer representatives. Determining if claims are valid under applicable worker's comp statutes. Communicating with medical providers to develop and authorize appropriate treatment plans. Reviewing and analyzing medical bills to confirm charges and treatment are worker's comp injury-related and in accordance with the treatment plan. Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes. Calculating and assigning appropriate reserves to claims, and managing reserve adequacy throughout the life of the claim. Managing claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets. Preparing required state filings within statutory limits. Providing information as needed for litigation or settlement negotiations. The ideal Claims Adjuster will have: Bachelor's degree preferred, but not required. At least 3 years' WC claims adjusting experience. Examiner designation or WC Claims Adjuster license. Experience with Georgia and Florida WC claims preferred. Strong verbal and written communication skills. Strong organizational skills with attention to details. Ability to work with little supervision. Ability to manage multiple tasks in a fast-paced environment. Proficiency in MS Word, Excel, and Outlook. Salary: 80-85k US per year, depending on experience. MIA offers the opportunity to join an established company in growth mode. Our benefits package includes medical, dental, vision, disability, and life insurance and 401(k) with employer match. We also offer a business casual work environment and an 8:00-5:00 Monday-Friday work week. Learn more about MIA at midwesterninsurance.com and K2 Insurance Services at k2ins.com.
$54k-74k yearly est. Auto-Apply 44d ago
Worker Compensation Claims Adjuster 2
Enlyte
Remote worker's compensation claims examiner job
At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth. Be part of a team that makes a real difference. This is a full-time remote position that can be located anywhere in the U.S. Must be able to work EST timezone * Investigates, evaluates, and resolves assigned Workers' Compensation claims of a more complex or litigated nature in a timely manner in accordance with legal statutes, policy provisions, and company guidelines. * Evaluate claimant eligibility; communicate with attending physician, employer and injured worker. * Work with both the claimant and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing treatment and related information. * Work directly with employers to facilitate a return to work, either on a full-time or modified duty basis. * Confirm coverage and applicable insurance policy or coverage document and statutory requirements. * Identify potential for third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate. * Identify potential for disability or pension credits or offsets and apply same where appropriate. * Ensure timely denial or payment of benefits in accordance with jurisdictional requirements. * Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure. * Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws. * Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution. * Where litigation is filed, evaluate exposure and work with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim. * Close all files as appropriate in a timely and complete manner. * Maintain closing ratio as directed by management team. * Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees' medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable. * Complete PARs (payment authorization request) when applicable. * Comply with all excess and reinsurance reporting requirements; manage self-insured retention reporting. Qualifications * High School diploma required. * Associate's or Bachelor's degree preferred. * 2 years of experience handling workers' compensation claims. * Completion of Workers' Compensation training courses internally and/or externally in all significant areas affecting Workers' Compensation claims handling and practices. * Workers' Compensation licenses, certifications, awards preferred. Benefits We're committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $20.96 - $24.03 hourly, and will be based on a number of additional factors including skills, experience, and education. The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability. Don't meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles. #LI-FP1 #LI-Remote
$21-24 hourly 60d+ ago
Sr Claims Examiner I
Penn Mutual 4.8
Remote worker's compensation claims examiner job
The Sr Claims Examiner I is an independent and self-sufficient professional who handles death claims with moderate complexity. This may include processing claims within Life, Annuity, RPS, or a combination of the three. This role ensures accurate processing in accordance with contract provisions, policies, and regulatory guidelines. While capable of handling routine and moderately complex cases independently, highly complex or unusual cases are escalated for review. This position serves as a developmental senior role, building expertise and judgment for future advancement. Responsibilities Review and adjudicate standard and moderately complex life and annuity claims in compliance with policies and regulations. Adjudicates and pays claims within established service level agreements (SLAs) up to $1M. Validate beneficiary designations and process payments accurately within documented procedures and team SLAs. Applies established procedures and regulatory guidelines to determine if requests are in “good order.” Identify and escalate highly complex or unusual cases to senior team members or management. Maintain accurate records and documentation for all claims handled. Communicate effectively with beneficiaries, agents, and internal stakeholders to resolve inquiries and champion strong relationship building and customer service. Navigate multiple administrative systems, workflows, and imaging tools simultaneously with a high level of organization and attention according to standard operating procedures (SOPs). Participate in training and development activities to enhance technical knowledge and skills. Adheres to Service Level Agreements (SLAs) and individual/team metrics. Ability to work core business hours between 8:30 AM to 6:00 PM EST. Knowledge, Skills, and Abilities Strong attention to detail and organizational skills. Ability to work independently and manage assigned workload efficiently. Foundational knowledge of life insurance products and claims processes. Strong customer service mindset with demonstrated professionalism, empathy, accountability and ownership. Strong analytical mindset with proven problem-solving abilities and math skills. Effective written and verbal communication skills. Proficiency with digital tools and claims systems. Demonstrated accuracy, organization skills, and ability to work to meet deadlines and SLAs. Ability to learn and adapt to changing procedures and regulations. Ability to work with others in a collaborative team environment. Demonstrated ability to learn and apply new digital tools, including AI applications such as Microsoft CoPilot. Education Bachelor's degree preferred or equivalent work experience. Experience 3-5 years of experience in life, annuity, or RPS claims or related field. Certifications Industry certifications (e.g., ALHC, FLMI, Series 6 or 26, HIAA, etc.) are a plus but not required. Salary Range: $55,000- $65,000 For over 175 years, Penn Mutual has empowered individuals, families and businesses on the journey to achieve their financial goals. Through our partnership with Financial Professionals across the U.S., we help instill the confidence and reliability that comes from a stronger financial future. Penn Mutual and its affiliates offer a comprehensive suite of competitive products and services to meet the unique needs of Financial Professionals and their clients, including life insurance, annuities, wealth management and institutional asset management. To learn more, including current financial strength ratings, visit ******************* Penn Mutual is committed to Equal Employment Opportunity (EEO). We provide employment and advancement opportunities to all qualified applicants and associates, according to applicable laws. This is reflected in our practices for hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment, compensation, selection or training, and all other terms and conditions of employment. All employment-related decisions and practices are free from unlawful discrimination. This includes: race, creed, color, national origin, ancestry, citizenship age, gender (including pregnancy), sexual orientation, gender identity or expression, domestic partnership or civil union status, marital status, genetic information, disability, religious observance or practice, liability, veteran status or any other classification protected under applicable law.
$55k-65k yearly Auto-Apply 5d ago
Sr. Workers' Compensation Claims Specialist, Supervisor - REMOTE
Holmes Murphy 4.1
Remote worker's compensation claims examiner job
We are looking to add a Sr. Workers' Compensation Claims Specialist, Supervisor to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in multiple states. This team member will provide high quality claims handling oversight and expertise for all CRS customers on litigated and complex claim situations. This includes assisting staff supervised with investigating, communicating, evaluating, and resolving claims utilizing the CRS Best Practice of Claim Handling. Assisting claim staff with goals, career pathing, and ensuring engagement. Essential Responsibilities: Claims Management: Adjudicate claims during staffing shortages, investigate, and negotiate settlements per “Best Practices for Claims.” Monitor and document claim files, focusing on Coverage, Investigation, Reserves, Plan of Action, Legal, and Medical Management. Recommend adjustments as needed. Research and respond to questions and complaints from insureds, claimants, agency partners, and fronting carriers. Discuss complex claims and coverage issues with clients, addressing any inquiries. Maintain communication with customers and fronting carriers per “CRS Communication Expectations” and “Reportable” file guidelines. Assist staff in managing litigation claims, ensuring timely responses and protecting the interests of insured and carriers. Management Responsibilities: Ensure appropriate staffing, including hiring and terminations. Coach team members on workflow, processes, customer service, and client consulting. Conduct performance reviews, set goals, and hold employees accountable. Foster career development and manage timesheets and compensation decisions Coordinate training and maintain standardized processes for quality service. Facilitate regular team meetings and attend enterprise and leadership training. Additional Responsibilities: Conduct monthly performance meetings and quarterly team meetings. Set and monitor annual goals for staff. Participate in round tables, claim reviews, and Risk Control Workshops. Mediate between insured and insurance company, addressing coverage issues and large loss reporting. Analyze performance data to implement necessary changes. Review all files at least every 90 days. Qualifications: Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. Experience: 5+ years of adjusting property and casualty claims, including litigated claims. Prior agency, loss control or carrier experience preferred. Prior supervisory experience preferred. Licensing: Active state specific Workers Compensation License required or the ability to acquire license within three months of hire. Skills: Extensive knowledge of General and Auto Liability or Workers Compensation coverages and application in job duties, proficient in claims processing procedures, knowledge or ability to learn multiple state insurance regulations; pass state licensing exams. Technical Competencies: An ideal candidate will have a strong grasp of claims principles, practices, and insurance coverage interpretation, contributing to workflows and adhering to compliance requirements. They will prioritize problem-solving, actively foster relationships, and collaborate to deliver impactful solutions and a world-class client experience. Here's a little bit about us: Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies. In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey! Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow. 401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k. This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do. After all, you can't be at your best for our clients if you're not at your best for yourself first. Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish! Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing. Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money. Who doesn't love that?! The salary range for this role is $65,000- $109,000. Compensation is based on several factors, including, but not limited to, education, work experience and industry certifications. In addition to your salary, Holmes Murphy offers a comprehensive total rewards program including annual bonuses, total wellbeing benefits and support for professional development. #LI-EG1 #Remote
$65k-109k yearly Auto-Apply 60d+ ago
Sr. Workers' Compensation Claims Specialist, Supervisor - REMOTE
HMA Group Holdings 3.7
Remote worker's compensation claims examiner job
We are looking to add a Sr. Workers' Compensation Claims Specialist, Supervisor to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in multiple states. This team member will provide high quality claims handling oversight and expertise for all CRS customers on litigated and complex claim situations. This includes assisting staff supervised with investigating, communicating, evaluating, and resolving claims utilizing the CRS Best Practice of Claim Handling. Assisting claim staff with goals, career pathing, and ensuring engagement. Essential Responsibilities: Claims Management: Adjudicate claims during staffing shortages, investigate, and negotiate settlements per “Best Practices for Claims.” Monitor and document claim files, focusing on Coverage, Investigation, Reserves, Plan of Action, Legal, and Medical Management. Recommend adjustments as needed. Research and respond to questions and complaints from insureds, claimants, agency partners, and fronting carriers. Discuss complex claims and coverage issues with clients, addressing any inquiries. Maintain communication with customers and fronting carriers per “CRS Communication Expectations” and “Reportable” file guidelines. Assist staff in managing litigation claims, ensuring timely responses and protecting the interests of insured and carriers. Management Responsibilities: Ensure appropriate staffing, including hiring and terminations. Coach team members on workflow, processes, customer service, and client consulting. Conduct performance reviews, set goals, and hold employees accountable. Foster career development and manage timesheets and compensation decisions Coordinate training and maintain standardized processes for quality service. Facilitate regular team meetings and attend enterprise and leadership training. Additional Responsibilities: Conduct monthly performance meetings and quarterly team meetings. Set and monitor annual goals for staff. Participate in round tables, claim reviews, and Risk Control Workshops. Mediate between insured and insurance company, addressing coverage issues and large loss reporting. Analyze performance data to implement necessary changes. Review all files at least every 90 days. Qualifications: Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. Experience: 5+ years of adjusting property and casualty claims, including litigated claims. Prior agency, loss control or carrier experience preferred. Prior supervisory experience preferred. Licensing: Active state specific Workers Compensation License required or the ability to acquire license within three months of hire. Skills: Extensive knowledge of General and Auto Liability or Workers Compensation coverages and application in job duties, proficient in claims processing procedures, knowledge or ability to learn multiple state insurance regulations; pass state licensing exams. Technical Competencies: An ideal candidate will have a strong grasp of claims principles, practices, and insurance coverage interpretation, contributing to workflows and adhering to compliance requirements. They will prioritize problem-solving, actively foster relationships, and collaborate to deliver impactful solutions and a world-class client experience. Here's a little bit about us: Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies. In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey! Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow. 401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k. This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do. After all, you can't be at your best for our clients if you're not at your best for yourself first. Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish! Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing. Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money. Who doesn't love that?! The salary range for this role is $65,000- $109,000. Compensation is based on several factors, including, but not limited to, education, work experience and industry certifications. In addition to your salary, Holmes Murphy offers a comprehensive total rewards program including annual bonuses, total wellbeing benefits and support for professional development. #LI-EG1 #Remote
$65k-109k yearly Auto-Apply 8d ago
Senior Claims Specialist - Construction Defect - Remote
Cfins
Remote worker's compensation claims examiner job
Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2025 Great Place to Work Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: ************** Job Description Crum & Forster is looking for a Sr. Claims Specialist who enjoys being a key part of a dynamic team. As a Sr. Claims Specialist, you will manage an assigned pending of Construction Defect claims. You will be expected to operate under appropriate levels of supervision and within established authority. The position will report to assigned Manager, Director or Vice President, as determined by business needs. This role is open to be filled at the Claims Specialist or Senior level role, depending on the skills and experience of the candidate. What you will do for C&F: Receive claim assignments, verify and determine applicability of coverage. Ability to not only interpret complex coverage issues, but possess the ability to write appropriate reservation of rights and declination of coverage letters. Determine the method and extent of investigation for each claim as required by company Best Practices. Review and manage claim files, as assigned, for adequacy and timeliness of investigation, evaluation and reserve, and maintain a timely diary for each claim. Evaluate and adjust claims within the adjuster's authority level. Report directly on technical matters to supervisor or management. Evaluate and manage litigated claims, determine future course of handling and proper method of disposition. Consult with the assigned Manager, Director or Coverage unit on those claims in which assistance and consultation is needed, as well as on those claims which exceed assigned authority. Assess risk transfer potential and development of information required to successfully address tender issues. Assess recovery potential and development of information required to successfully pursue recovery. Accountable for the equitable and prompt adjustment and management of assigned claims to disposition in accordance with company Best Practices. Responsible for providing superior customer service to all agents, insureds, and others encountered during the claims handling process. What you will bring to C&F: Minimum of three years Construction Defect claims or similar legal experience. College degree is required or equivalent experience. An insurance designation and/or insurance related courses are a plus. Obtain and maintain required state licenses. Excellent verbal and written communication skills are essential and the ability to communicate with all levels within the organization. Computer skills with a working knowledge of the Microsoft Office suite of programs a must. Travel occasionally required. What C&F will bring to you Competitive compensation package Generous 401K employer match Employee Stock Purchase plan with employer matching Generous Paid Time Off Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family's wellness, including your physical, mental and financial wellbeing A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path A dynamic, ambitious, fun and exciting work environment We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community At C&F you will BELONG If you require special accommodations, please let us know. We value inclusivity and diversity. We are committed to equal employment opportunity and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodations, please let us know For California Residents Only: Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit **************************************************************** for more information. Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws. Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $55,800.00 to a maximum of $104,900.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee's contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs. #LI-AV1 #LI-Remote
$55.8k-104.9k yearly Auto-Apply 19h ago
Sr Claims Examiner- MSI
The Baldwin Group 3.9
Remote worker's compensation claims examiner job
Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. The Sr Claims Examiner is considered an expert in managing insurance claims for our policyholders, handling claims with high severity and complexity. The Sr Claims Examiner must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position. The Sr Claims Examiner must be able to work with little to minimal supervision PRIMARY RESPONSIBILITIES: • Analyzes insurance policies and other documents to determine insurance coverage. • Investigates and analyzes claim information to determine extent of liability. • Handles claims 1st Party Property Claims with complex to major severity. • Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation. • Sets timely, adequate reserves in compliance with the company's reserving philosophy. • Engages experts to assist in the evaluation of the claim. • Monitors vendor performance and controls expense costs. • Evaluates, negotiates and determines settlement values. • Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties. • Handles all claims in accordance with Best Practices. • Responsible for monitoring and completing assigned claims inventory. • Acquire and maintain a state adjuster's license and meet state continuing education requirements. • Provides Best-In-Class customer service for insureds and agents. • Develops and maintains relationships with external and internal stakeholders. • Acts as a mentor for less experienced Claims Examiners. • Updates and maintains the claim file. • Identifies opportunities for subrogation and ensures recovery interests are protected. • Identifies fraud indicators and refers files to SIU for further investigation. • Participates in claims audits, internal and external. • Provides oversight of TPAs • Assists with special projects KNOWLEDGE, SKILLS & ABILITIES: EDUCATION & EXPERIENCE: High School/GED 10+ year's experience in claims Must have Property & Casualty Insurance License #LI-JW2 #LI-REMOTE Click here for some insight into our culture! The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.
$44k-65k yearly est. Auto-Apply 2d ago
Sr. Commercial Casualty Claims Specialist (Remote)
Aaaie
Remote worker's compensation claims examiner job
External candidates: In order for your application to be correctly processed please sign-in before you apply Internal candidates: Please go to Workday and click "Find Jobs" link under Career Thank you for considering opportunities with us! Job Title Sr. Commercial Casualty Claims Specialist (Remote) Requisition Number R7503 Sr. Commercial Casualty Claims Specialist (Remote) (Open) Location Colorado - Home Teleworkers Additional Locations Alabama - Home Teleworkers, Alabama - Home Teleworkers, Arizona - Home Teleworkers, Arkansas - Home Teleworkers, California - Home Teleworkers, Connecticut - Home Teleworkers, Delaware - Home Teleworker, District of Columbia - Home Teleworkers, Florida - Home Teleworkers, Georgia - Home Teleworkers, Idaho - Home Teleworkers, Illinois - Home Teleworkers, Indiana - Home Teleworkers, Iowa - Home Teleworkers, Kansas - Home Teleworker, Kentucky - Home Teleworkers, Louisiana - Home Teleworkers, Maine Home Teleworkers, Maryland - Home Teleworkers, Massachusetts - Home Teleworkers, Michigan - Home Teleworkers, Minnesota - Home Teleworkers, Mississippi - Home Teleworker, Missouri - Home Teleworker, Montana - Home Teleworkers {+ 20 more} Job Information We're Mobilitas, a commercial insurance company created by CSAA Insurance Group. Our mission is to reinvent commercial insurance in the mobility space by providing technologically advanced solutions for today's way of doing business. At Mobilitas, we believe in what's possible and we use our inventive skills to meet the demands of modern mobility with tailored solutions. We're looking for motivated, innovative individuals who think big, move fast and are dedicated to creating a company from the ground up, without the constraints of a traditional insurance company. We're excited to push the boundaries of commercial insurance and are looking for enthusiastic team members to help us reimagine insurance. We are actively hiring for a Sr. Commercial Casualty Claims Specialist. Your Role: As a Sr. Commercial Casualty Claims Specialist, you will be responsible to resolve all aspects of 1st and 3rd party injury claims of low to moderate complexity for personal lines as well as our commercial claims. Your duties will require you to become licensed in several states as you will be handling claims in a multitude of regions across the nation. Your Work: Manage all claims efficiently and effectively to an appropriate resolution with minimal supervision. Handle all aspects of liability injury claims of low to moderate complexity to include all coverage, liability and damage concerns. Handle 1st party exposures to include Medical Payment coverage, PIP, Uninsured Motorists, Under-insured Motorists claims as well as ADB (Auto-Death Benefit) claims. Assist in taking first notice of loss calls (FNOL) and participate in the department phone queue as needed. Make coverage determinations and conduct investigative work of a complex nature, advising customers as to accurate course of action related to coverage issues. Make appropriate liability determinations based upon the evidence gathered. Evaluate any potential for subrogation and initiate an initial notice of subrogation request. Develop negotiation strategies to resolve claims effectively and efficiently with insureds, claimants, or representatives of the injured parties. Communicate pertinent case facts to a supervisor, manager or committee when appropriate. Actively shapes our company culture (e.g., participating in employee resource groups, volunteering, etc.). Lives into cultural norms (e.g., willing to have cameras when it matters: helping onboard new team members, building relationships, etc.). Travels as needed for role, including divisional / team meetings and other in-person meetings. Fulfills business needs, which may include investing extra time, helping other teams, etc. Required experience, education, and skills: 4-5 years of claims experience with a minimum of 3-5 years in casualty adjuster experience. High school (HS/GED) or a minimum of 3 years experience in casualty claims role within P&C insurance industry. Must hold an Adjuster's license for all applicable states or obtain license(s) within 90 days of filling position as a condition of employment. What would make us excited about you: 5+ years of casualty claims adjuster experience. BA/BS in business, insurance or related area, or equivalent combination of education and experience. Commercial Claims handling experience. Bilingual (Spanish) a plus. Actively shapes our company culture (e.g., participating in employee resource groups, volunteering, etc.). Lives into cultural norms (e.g., willing to have cameras when it matters: helping onboard new team members, building relationships, etc.). Travels as needed for role, including divisional / team meetings and other in-person meetings. Fulfills business needs, which may include investing extra time, helping other teams, etc. Mobilitas Careers At Mobilitas, we're proudly devoted to protecting our customers, our employees, our communities, and the world at large. We are on a climate journey to continue to do better for our people, our business, and our planet. Taking bold action and leading by example. We are citizens for a changing world, and we continually change to meet it. Join us if you… BELIEVE in a mission focused on building a community of service, rooted in inclusion and belonging. COMMIT to being there for our customers and employees. CREATE a sense of purpose that serves the greater good through innovation. Recognition: We offer a total compensation package, performance bonus, 401(k) with a company match, and so much more! Read more about what we offer and what it is like to be a part of our dynamic team at careers.mobilitasinsurance.com. In most cases, you will have the opportunity to choose your preferred working location from the following options when you join us: remote, hybrid, or in-person. Submit your application to be considered. We communicate via email, so check your inbox and/or your spam folder to ensure you don't miss important updates from us. If a reasonable accommodation is needed to participate in the job application or interview process, please contact *************************** As part of our values, we are committed to supporting inclusion and diversity. We actively celebrate colleagues' different abilities, sexual orientation, ethnicity, and gender. Everyone is welcome and supported in their development at all stages in their journey with us. We are always recruiting, retaining, and promoting a diverse mix of colleagues who are representative of the U.S. workforce. The diversity of our team fosters a broad range of ideas and enables us to design and deliver a wide array of products to meet customers' evolving needs. Mobilitas is an equal opportunity employer. If you apply and are selected to continue in the recruiting process, we will schedule a preliminary call with you to discuss the role and will disclose during that call the available salary/hourly rate range based on your location. Factors used to determine the actual salary offered may include location, experience, or education. Must have authorization to work indefinitely in the US Please note we are hiring for this role remote anywhere in the United States with the following exceptions: Hawaii and Alaska. #LI-CH1 #HP_RX .
$50k-82k yearly est. Auto-Apply 8d ago
Sr. Commercial Trucking Litigation Claims Examiner | Remote
King's Insurance Staffing 3.4
Remote worker's compensation claims examiner job
Our client is seeking to add a Senior Commercial Auto Litigation Claims Examiner to their team. This individual will be responsible for overseeing complex commercial auto claims, with a strong focus on litigated matters and severe casualty exposures. The role requires managing the claim process from initial intake through final resolution, including evaluating coverage, directing litigation strategy, and negotiating settlements across multiple jurisdictions. This position offers the ability to work fully remote. Key Responsibilities: Investigate, evaluate, and resolve litigated Commercial Auto claims from inception through closure. Analyze liability, damages, and legal exposure to determine appropriate resolution strategies. Establish timely and appropriate reserves based on investigation and litigation progression. Partner with defense counsel, insureds, and other experts to effectively manage claims and litigation costs. Conduct coverage analysis and issue detailed coverage position letters when necessary. Prepare reports and updates for senior leadership, clients, and other stakeholders. Maintain consistent communication with policyholders, attorneys, and internal teams throughout the claim lifecycle. Ensure timely file documentation in compliance with company, client, and regulatory standards. Negotiate settlements in line with company/client authority and jurisdictional requirements. Stay current on evolving laws, regulations, and litigation trends impacting commercial auto liability. Requirements: 10+ years of Commercial Auto / Trucking Bodily Injury Litigation claims handling experience. Must have 4+ years of Commercial Trucking experience. Strong knowledge in MCS 90 is strongly desired. Active Adjuster's License required. Proven experience managing litigated claims and working directly with defense counsel. Strong negotiation, litigation management, and analytical skills. Excellent written and verbal communication skills, including drafting detailed coverage letters and litigation reports. Highly organized, self-motivated, and able to independently manage a remote workload. Proficient in Microsoft Office and claims management systems. Salary & Benefits: $90,000 - $120,000+ annually (depending on experience) Comprehensive Medical, Dental, and Vision coverage 401(k) with company match Paid Time Off and holiday benefits Professional development and career advancement opportunities
$37k-48k yearly est. 60d+ ago
Sr USDA Claims Recovery & Analysis Loss Specialist
Carrington Mortgage Services, LLC 4.5
Remote worker's compensation claims examiner job
Come join our amazing team and work remote from home! The Sr Claims &Recovery Analysis Loss Specialist is responsible for ensuring the proper incurred losses were identified and the financial reconciliation is accurately completed on all liquidated loans. Key reviewer of loss analysis decisions which include validating the determined responsibility and root cause for avoidable losses, ensuring they meet quality expectations and reflect proper decision rationale and supporting evidence and identify any bill back opportunities. Perform all duties in accordance with the company's policies and procedures, all US state and federal laws and regulations, wherein the company operates. The target pay for this position is $23.00/hr - $26.50/hr. What you'll do: Review reconciliation of all loan advances once the GSE or Government Mortgage Insured "expense" claim has been paid. * Confirm all prior tasking in LoanServ has been completed as well as update approval tasks as required per job aid upon the date the action occurs. * Issue corrections identified during the Quality Review Process, communicating findings to Loss Specialist for remediation. Ensure Loss Specialist provides corrections as needed. * Responsible for learning new skills and expand job knowledge to better perform assigned duties. * Maintain monthly performance in alignment with quality expectations. * Analyze multiple data elements in order to confirm the proper decision rationale and approve evidentiary support is included and written summaries are accurate. * Validate research on incurred losses, using analytical skills and subject matter knowledge to confirm responsibility and bill back opportunities. * Responsible for staying abreast of relevant changes to GSE or Government Mortgage Insured guidelines, industry standards and client expectations. * Ensure timely completion of projects and tasks when assigned. If unable to meet a deadline, the deadline must be renegotiated prior to the initial deadline date. * Look for opportunities to improve the department's processes and procedures, to reduce costs and eliminate non-essential and manual processes and activities. * Keep Team Lead and Supervisor informed of all trends and problems including, but not limited to, exceptions identified in review of Loss Analysis processes. * Moderate working knowledge of all Default Servicing processes up to and including Loss Mitigation, Bankruptcy, Foreclosure, Conveyance and Claims in addition to mortgage servicing state, federal and agency guidelines and timelines. * Moderate background in financial and loss analysis including ability to determine: all funds/advances due CMS have been recovered. * Moderate ability to conduct quality assurance reviews. * Preferred Accounting Background--Must possess the ability to complete financial reconciliations. * Moderate computer skills with MS Word, Excel. * Strong attention to details and excellent time management and organizational skills. * Comprehensive writing skills, including proper punctuation and grammar, organization, and formatting. * Ability to work under general direction to accomplish department goals and reduce/mitigate financial loss to CMS and its Clients. * Ability to substantiate facts and properly document them. * Ability to work effectively and develop rapport with all levels of staff, management, Investors/Insurers and 3rd parties. * Ability to make decisions that have moderate impact to immediate work unit. * Ability to identify urgent matters requiring immediate action and properly escalating them. * Ability to handle multiple tasks under pressure and changing priorities. What you'll need: * High School diploma required; Associate/Bachelor Degree in accounting or other related field preferred. * Two (2) or more years' quality assurance experience. * Three (3) or more years' Loan Servicing platform experience for all default related activities such as Foreclosure, Bankruptcy, Default MI Claims, Loss Mitigation, etc. * Previous FHA, VA, USDA and PMI claims experience preferred Our Company: Carrington Mortgage Services is part of The Carrington Companies, which provide integrated, full-lifecycle mortgage loan servicing assistance to borrowers and investors, delivering exceptional customer care and programs that support borrowers and their homeownership experience. We hope you'll consider joining our growing team of uniquely talented professionals as we transform residential real estate. To read more visit: *************************** What We Offer: * Comprehensive healthcare plans for you and your family. Plus, a discretionary 401(k) match of 50% of the first 4% of pay contributed. * Access to several fitness, restaurant, retail (and more!) discounts through our employee portal. * Customized training programs to help you advance your career. * Employee referral bonuses so you'll get paid to help Carrington and Vylla grow. * Educational Reimbursement. * Carrington Charitable Foundation contributes to the community through causes that reflect the interests of Carrington Associates. For more information about Carrington Charitable Foundation, and the organizations and programs, it supports through specific fundraising efforts, please visit: carringtoncf.org. Notice to all applicants: Carrington does not do interviews or make offers via text or chat. #LI-SY1
$23-26.5 hourly 12d ago

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Updated January 16, 2026

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