Job Profile Job Title: Claims Examiner Location: Remote Hire Type: Contingent Pay Range: $43 - $45 Work Model: Remote Work Shift: Monday-Friday 8 am – 4:30 pm Recruiter Contact: Sean Craft I sean@marykraft.com I 443-345-3305 Nature & Scope: Positional Overview We are seeking an experienced Workers’ Compensation Claims Examiner to join our remote team. This role is responsible for analyzing, investigating, and managing lost-time workers’ compensation claims from start to finish. The ideal candidate has at least 3+ years of relevant WC experience and the ability to handle complex, high-exposure cases involving litigation, return-to-work coordination, and state compliance. Role & Responsibility: Tasks That Will Lead to Your Success Review, investigate, and analyze complex or technically difficult lost-time workers’ compensation claims to determine coverage, benefits, and appropriate next steps. Develop and execute strategic claim action plans to ensure a timely and appropriate resolution. Establish and monitor reserves; adjust as necessary throughout the life of the claim. Process benefit payments, settlements, and adjustments within designated authority levels. Ensure all state filings and regulatory documentation are completed within statutory deadlines. Coordinate with legal, medical, and vendor partners to manage litigation and reduce overall claim costs. Evaluate and pursue subrogation and recovery opportunities, including Second Injury Fund and Medicare offsets. Communicate clearly and professionally with injured workers, clients, attorneys, and internal teams. Maintain accurate documentation and ensure compliance with claims coding and audit requirements. Report claims to excess carriers and respond to inquiries and directions promptly. Escalate complex or sensitive cases to management as appropriate. Skills & Experience Qualifications That Will Help You Thrive High School Diploma or GED required. Bachelor’s degree preferred. Professional certifications in claims or insurance (e.g., AIC, CPCU) preferred. Minimum 3 years of hands-on Workers’ Compensation claims experience (including lost time ) is required . Experience handling claims in a multi-state environment is a plus. Strong knowledge of workers’ compensation laws, regulations, and medical management practices. Proficiency in Microsoft Office Suite (Word, Excel, Outlook). Excellent written and verbal communication skills. Strong analytical, organizational, and negotiation abilities. Ability to manage multiple claims and meet tight deadlines in a remote environment. High level of professionalism, judgment, and discretion.