Workers Compensation Claims Examiner II

DecisionHR is a Professional Employer Organization (PEO) located in St Petersburg, FL. Since our inception in 1996, we have empowered our clients with industry-leading human resource solutions they need to drive their business. We assist our clients in the areas of payroll, worker's compensation, human resources, and benefits. We remove the administrative burden of running their business and allow our clients to focus on their revenue-producing activities. Our goal is to deliver customizable, practical workforce solutions that increase profits, reduce costs and liability, and attract, develop, and retain long-term employees.
Our Core values include:

Collaboration : working together is critical to achieving organizational goals.

Innovation : growth happens when we can absorb and implement new ideas that provide unique solutions and superior customer service.

Performance : we believe in providing our employees with the tools and support they need to grow, succeed, and make an impact.

Social Responsibility : we place charity and volunteer work at the core of our organization.

Trust: we build and maintain trust with our employees and clients by embodying integrity, transparency, and 'doing the right thing.'

Summary/Objective
The Workers Compensation Claims Examiner II is a highly skilled professional responsible for managing complex and high-exposure workers' compensation claims, ensuring strategic resolution and optimal cost management. This role serves as the escalation point for claims requiring advanced expertise while maintaining a consultative role in quarterly reporting, risk mitigation, and client advisement. Unlike traditional managerial positions, this role does not include direct supervisory responsibilities but remains integral in enhancing claims processes, mentoring claims staff, and streamlining communication between key stakeholders.


Key Responsibilities


Claims Escalation & Complex Case Resolution
- Serve as the lead consultant for high-exposure, litigated, and complex claims that exceed examiner authority. Manages a book of high-exposure claims (> $100K in open reserves).
- Analyze coverage, liability, and damages to recommend optimal settlement strategies.
- Work closely with defense counsel, adjusters, DHR Claims Examiners, and third-party administrators (TPAs) to mitigate risk.
- Provide expert recommendations on reserving strategies to ensure financial accuracy.


Client & Stakeholder Communication
- Consult with internal teams and clients to optimize employer-level claim investigations and mitigation strategies.
- Communicate concise, data-driven insights to clients, ensuring clarity in claim development and financial impact.
- Serve as a liaison between claims adjusters, risk management, and loss prevention teams to facilitate improved outcomes.


Data Analysis & Strategic Reporting
- Conduct monthly and quarterly trend analysis to identify emerging risks, cost drivers, and loss trends.
- Utilize industry benchmarks and analytics tools to develop data-driven claims strategies.
- Contribute to organizational risk management efforts by presenting actionable insights to senior leadership.


Process Improvement & Operational Efficiency
- Assist in standardizing claims documentation, reporting, and tracking methodologies.
- Provide mentorship and subject-matter expertise to claims examiners while ensuring best practices in claims handling.


Qualifications & Skills

Required Experience & Technical Skills
- 3 to 5 years of experience in multi-state workers' compensation claims management with a PEO, insurance carrier, or brokerage.
- Strong expertise in claims litigation, financial reserving, medical management, and return-to-work programs.
- Proven ability to synthesize claims data into strategic risk management insights.


Soft Skills & Communication
- Strategic thinker with the ability to balance thorough investigation with efficient execution.
- Strong interpersonal skills to build relationships with claims adjusters, defense counsel, and client companies.



Preferred Experience
- Bachelor's degree in risk management, business, or related field.
- Advanced claims certifications (e.g., AIC, ARM, CPCU) preferred.


The preceding position description has been designed to indicate the general nature of the work performed; the level of knowledge and skills typically required; and the usual working conditions of this position. It is not designed to contain or be interpreted as a comprehensive, complete, or exclusive list of the duties of the position. Additional and different duties may be assigned from time to time. We are an E-Verify company. to