Top 573 Claims examiner Jobs

Workers' Compensation Claims Examiner
RizeUp Technology Staffing —Washington, DC
- $35 an hour
- Temporary
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
2d
Casualty Claims Examiner
GEICO —Richardson, TX
- Full-time
- Hybrid work
- Customer service
- Mid-level
- Office
Claims - Claims Examiner
Wellcove —Remote
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
TPA Commercial Claims Examiner
Schifrin, Gagnon, & Dickey, Inc. —Remote
- $72,000 - $85,000 a year
- Remote
- 5 years
- Writing skills
- Senior level
- Dental insurance
- Flexible spending account
Quick Apply
Claims - Examiner, Claims
Wellcove —Remote
- Full-time
- Remote
- Background check
- Anatomy knowledge
- Basic math
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Claims Examiner – Spinnaker
Hippo Insurance —Dallas, TX
- $85,000 - $120,000 a year
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Disability insurance
- Dental insurance
Quick Apply
1d
Inland Marine & Cargo Claims Examiner
Raphael and Associates —Remote
- Full-time
- Customer service
- Analysis skills
- Senior level
- Health insurance
- Dental insurance
Quick Apply
Claims Examiner
Firstsource Healthcare —Remote
- $17 - $20 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
Sr. Claims Examiner
Transamerica —Remote
- $48,000 - $53,000 a year
- Full-time
- 5 years
- Writing skills
- Analysis skills
- Wellness program
- Paid parental leave
23h
Claims Examiner, DRC
Arch Capital Group Ltd. —Philadelphia, PA
- $72,000 - $90,000 a year
- Full-time
- Hybrid work
- Microsoft Outlook
- Customer service
- Mid-level
- Paid parental leave
- AD&D insurance
23h
Claims Examiner
Chubb —Simsbury, CT
- Full-time
- Mid-level
- Office
- Leadership
- On-the-job training
3d
PET INSURANCE CLAIMS EXAMINER/ADJUSTER 1099 INDEPENDENT CONTRACTOR
Administrative Strategies —Remote
- Weekends as needed
- Background check
- Spanish
- Anatomy knowledge
- Pet insurance
Quick Apply
Claims Examiner
Securian Financial Group —Saint Paul, MN
- $21.54 - $37.64 an hour
- Full-time
- Hybrid work
- Office
- Analysis skills
- Organizational skills
- Paid holidays
- Disability insurance
14d
Claims Examiner
Gallagher —Oakland, CA
- $79,500 - $113,500 a year
- Remote
- 5 years
- Writing skills
- Mid-level
Claims Examiner
Midwest Operating Engineers Fringe Benefit Fund —Countryside, IL
- $33.23 an hour
- Full-time
- Anatomy knowledge
- HIPAA
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Claim Examiner
A-G Specialty Insurance, LLC —Berwyn, PA
- $50,000 a year
- Weekends as needed
- Remote
- Mid-level
- Bachelor's degree
- Travel
Life Claims Examiner
Primerica —Duluth, GA
- $45,000 - $55,000 a year
- Full-time
- Research
- Mid-level
- Organizational skills
- Health savings account
- Disability insurance
Workers Compensation Claims Examiner (TEXAS Jurisdiction)
Elite —Remote
- Urgently hiring
- Remote
- Management
- Bachelor of Science
- Basic math
- On-the-job training
Quick Apply
Examiner Physician Assistant
Loyal Source Government Services —Minneapolis, MN
- $149,094 - $179,094 a year
- Monday to Friday
- Microsoft Word
- Microsoft Outlook
- Military
Quick Apply
Claims Examiner III
Champion Health Plan is a Medicare Advantage Prescription Drug HMO C-SNP serving Medicare beneficiaries with End-Stage Renal Disease. —Long Beach, CA
- From $29 an hour
- Full-time
- Hybrid work
- Customer service
- Writing skills
- Office
- Health insurance
- Dental insurance
Quick Apply

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Workers' Compensation Claims Examiner

RizeUp Technology Staffing
Washington, DC

Quick Apply

Job Details

Temporary | Contract
$35 an hour
2 days ago

Qualifications

Report preparation
Customer communication
Customer service
Maintaining patient confidentiality
Writing skills
Workers' compensation insurance knowledge
Administrative experience
High school diploma or GED
Medical treatment knowledge
Data entry
Resource utilization in healthcare
Organizational skills
Microsoft Teams
Clerical experience
Grammar Experience
Medical terminology

Full Job Description

1) Receive, review, and process first reports of injury, notices of loss, and workers’ compensation claims in accordance with applicable laws, regulations, policies, and procedures.

2) Investigate and evaluate workers’ compensation claims to determine compensability and

injured worker entitlement to medical and related benefits.

3) Administer and manage medical-only workers’ compensation claims from inception

through closure, ensuring timely and accurate claim handling.

4) Collect, analyze, and evaluate claim-related information, including medical records, employment records, witness statements, treatment plans, billing documentation, and other supporting evidence.

5) Review medical evidence and documentation to assess the appropriateness of treatment, medical necessity, work restrictions, and return-to-work opportunities.

6) Conduct required claim contacts, including 24-hour four-point contacts with injured workers, supervisors, medical providers, and other stakeholders, and document all claim activities in the claims management system.

7) Develop and document factual findings, claim analyses, and recommendations to support claim determinations and benefit decisions.

8) Communicate and coordinate with injured workers, agency representatives, healthcare providers, legal counsel, nurse case managers, and other stakeholders regarding claim status, treatment plans, and return-to-work efforts.

9) Coordinate medical appointments, independent medical evaluations, transportation services, and follow-up care when medically necessary.

10) Assess maximum medical improvement (MMI) status, work capabilities, and ongoing treatment needs based on medical evidence and provider recommendations.

11) Draft notices, correspondence, claim determinations, and other documents related to the

administration and adjudication of workers’ compensation claims.

12) Maintain complete, accurate, and timely claim files and documentation in accordance with established records management requirements.

13) Research claim files, historical records, applicable laws, regulations, policies, and procedures to support claim investigations and determinations.

14) Manage assigned caseloads to ensure compliance with performance standards, statutory requirements, and customer service expectations.

15) Participate in claim reviews, settlement discussions, mediations, hearings, and other administrative proceedings, and provide testimony or supporting documentation as required.

16) Provide professional and responsive customer service while maintaining confidentiality and safeguarding sensitive medical, financial, and employment information.

17) Perform other related duties as assigned in support of the Public Sector Workers’

Compensation Program

General Clerk III

The assigned temporary personnel must possess the following qualifications:

1) Must have at least a high school degree or a Graduation Equivalent Degree (G.E.D.).

2) Minimum of five (5) years of professional administrative experience, including experience in high-volume data entry and clerical tasks.

3) Strong proficiency in operating a computer and Microsoft Office Suite (e.g., Word, Excel, PowerPoint, Outlook, Teams, etc.) to enter, store or retrieve various types of data, documents, and reports.

4) Must have knowledge of grammar, spelling and punctuation, and the required correspondence formats to ensure accuracy and adherence to established requirements.

5) Must have the ability to effectively communicate with others orally, in writing, and electronically, explain factual information, and formulate and present report conclusions.

6) Must have the ability to report in-person to 441 4th Street, NW, Washington, DC 20001 for five (5) days per week up to eight (8) hours per day.

7) Ability to perform more complex clerical duties, including research and reporting, while handling confidential and sensitive information with discretion.

8) Strong organizational skills with attention to detail and the ability to manage multiple tasks and deadlines efficiently.

Registered Nurse I

1) Graduation from an accredited professional nursing program recognized by the applicable state accrediting authority.

2) Current licensure as a Registered Nurse in the District of Columbia.

3) At least one (1) year of specialized professional nursing experience involving medical assessment, planning, implementation, utilization review, and evaluation of patient progress.

4) Clinical experience in orthopedics, neurology, rehabilitation, or utilization review.

5) Knowledge of clinical concepts, case management principles, healthcare regulations,

and workers’ compensation-related medical issues.

6) Strong analytical, communication, and interpersonal skills.

7) Proficiency with Microsoft Office applications and electronic medical/claims systems.

Workers’ Compensation Claims Examiners

1) Bachelor's degree and two (2) years of workers' compensation claims adjusting experience OR eight (8) years of progressively responsible claims handling experience including at least three (3) years of workers' compensation claims adjusting experience.

2) Knowledge of workers’ compensation laws, regulations, investigations, reserving, case

management, and claim adjudication.

3) Ability to analyze medical evidence and make claim determinations.

4) Experience participating in hearings, mediations, or settlement conferences.

5) Knowledge of medical terminology and treatment review.

6) Strong written and verbal communication skills.

7) Proficiency with Microsoft Office applications and claims management systems.

8) Ability to handle confidential and sensitive information with discretion.

Pay: $35.00 per hour

Expected hours: 40.0 per week

Work Location: In person

Quick Apply

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