Workers' Compensation Claims Examiner III - NJ/PA

Job Description

Job Description

Workers’ Compensation Claims Examiner III – NJ/PA

Location: Philadelphia, PA – Hybrid
Salary: $85,000–$95,000/year
Schedule: Hybrid – 2 Days In Office
Employment Type: Direct Hire

Overview

We are seeking an experienced Workers’ Compensation Claims Examiner III to join an established national claims organization. This is a senior-level opportunity for someone with strong New Jersey Workers’ Compensation claims experience who can independently manage complex indemnity claims from initial investigation through resolution.

This position offers a hybrid schedule, competitive salary, expanded claims authority, and the opportunity to manage a diverse multi-client caseload with minimal supervision.

What You Will Be Doing

• Manage approximately 125–150 Workers’ Compensation indemnity claims .

• Handle complex New Jersey Workers’ Compensation claims from initial report through resolution.

• Investigate claims and make compensability determinations.

• Administer benefits in accordance with state regulations and company guidelines.

• Review medical records, treatment requests, work status, and claim documentation.

• Authorize and coordinate appropriate medical treatment.

• Review and manage medical billing issues.

• Establish and adjust reserves based on claim exposure.

• Exercise expanded reserve and settlement authority appropriate to the Examiner III level.

• Develop claim strategies to drive timely and appropriate resolution.

• Refer claims to defense counsel and provide ongoing direction regarding litigation strategy.

• Review legal recommendations and monitor litigation developments.

• Negotiate settlements and obtain additional authority when necessary.

• Conduct independent claim file reviews.

• Maintain accurate documentation and a disciplined diary system.

• Communicate with clients regarding claim status, exposure, reserves, and resolution strategies.

• Identify injury trends and potential safety concerns.

• Coordinate with loss-control resources when appropriate.

• Maintain compliance with applicable Workers’ Compensation statutes and regulations.

What You Must Have

• 3–5+ years of Workers’ Compensation claims handling experience.

• Strong New Jersey Workers’ Compensation claims experience required.

• Experience handling complex indemnity claims independently.

• Strong knowledge of New Jersey Workers’ Compensation statutes and regulations.

• Experience with compensability decisions, investigations, medical management, reserves, litigation, and settlements.

• Ability to independently establish and adjust reserves.

• Experience managing outside defense counsel.

• Strong knowledge of medical terminology.

• Excellent written and verbal communication skills.

• Strong organizational and caseload-management skills.

Preferred

• Pennsylvania Workers’ Compensation claims experience.

• Bachelor’s degree.

• Microsoft Word and Excel proficiency.

• TPA or multi-client claims experience.

Why Join?

• $85,000–$95,000 annual salary

• Direct-hire opportunity

• Hybrid schedule – only 2 days per week in office

• Senior-level reserve and settlement authority

• Minimal supervision and greater autonomy

• Established defense counsel and loss-control support

• Diverse multi-client caseload

• Long-term career opportunity with an established organization

No claims license is required for this position.

Apply today if you have strong New Jersey Workers’ Compensation claims experience and are ready to take ownership of a senior-level claims desk.

Email your resume if you would like to apply!

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