Claims Examiner Workers Compensation I SE jurisdictions
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims Examiner Workers Compensation I – SE jurisdictions based in the United States.
This role involves managing and adjudicating workers’ compensation claims within Southeastern U.S. jurisdictions, ensuring timely and accurate resolution in line with regulatory and client requirements. You will analyze complex claims files, investigate facts, and determine appropriate benefit eligibility. The position plays a key role in delivering fair outcomes for claimants while controlling risk exposure for clients. You will communicate regularly with claimants, employers, and medical providers to ensure transparency throughout the claims process. Working in a fast-paced, remote-friendly environment, you will handle a diverse portfolio of cases across multiple industries. The role offers strong autonomy, professional growth opportunities, and exposure to global best practices in claims management. It is ideal for professionals who thrive in analytical, service-driven environments and value both precision and empathy in decision-making.
Accountabilities:
- Analyze, investigate, and manage workers’ compensation claims from intake through resolution, ensuring compliance with SE jurisdictional regulations and client guidelines.
- Develop and execute action plans to assess claim exposure, determine compensability, and drive timely claim closure.
- Negotiate settlements within delegated authority while balancing cost control and fair claimant outcomes.
- Communicate effectively with claimants, employers, medical providers, and clients to provide updates and clarify claim status.
- Report claims to excess carriers when required and respond promptly to information requests and case direction.
- Minimum 5 years of claims management or related experience, or equivalent combination of education and experience.
- High School Diploma or GED required; Bachelor’s degree preferred from an accredited institution.
- Experience handling workers’ compensation claims, preferably within FL, GA, LA, SC, NC, or TX jurisdictions.
- Strong understanding of claims adjudication processes, regulatory frameworks, and insurance best practices.
- Excellent analytical, negotiation, and decision-making skills with strong attention to detail.
- Effective communication skills with the ability to manage sensitive conversations professionally and empathetically.
- Relevant professional certifications are a plus depending on jurisdictional requirements.
- Competitive annual salary range with performance and experience-based consideration.
- Comprehensive health coverage including medical, dental, and vision insurance.
- 401(k) retirement plan with company match available from day one.
- Flexible work arrangements supporting remote work and work-life balance.
- Paid time off, disability coverage, life insurance, and employee assistance programs.
- Career development opportunities, training programs, and internal mobility pathways.
- Referral incentive programs and access to a diverse, global professional network.