Claims Examiner Jobs in the United States
Jobot
$19 - $21
San Antonio, TX
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. This position is responsible for accurately processing health plan delegated claims, addressing provider inquiries via phone, and handling various administrative tasks within the claims department.
BC Forward
$45 - $49.07
Ontario, CA
The ideal candidate will have strong experience in California workers' compensation, lost time claims, and litigation management and a proven ability to adjudicate complex claims, control costs, and drive timely, compliant resolutions. With delivery centers and offices across North America and India, we take pride in building long-term relationships and delivering excellence through innovation, collaboration, and integrity.
Iconma
New Haven, CT
Claim Examiner position with prior experience in workers’ compensation as a claim examiner, or commensurate examiner experience in paralegal, short-term / long-term disability, auto personal injury protection / medical injury, general liability, medical billing or as a claim technical assistant for lost time claims. Works with in-house Technical Assistants, Special Investigators, Nurse Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.
Vaco LLC
$45000 - $50000
Brookhaven, GA
Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to: the individual’s skill sets, experience and training; licensure and certification requirements; office location and other geographic considerations; other business and organizational needs. Determining compensation for this role (and others) at Vaco/Highspring depends upon a wide array of factors including but not limited to the individual’s skill sets, experience and training, licensure and certifications, office location and other geographic considerations, as well as other business and organizational needs.
Iconma
Alpharetta, GA
Keep all files on a current diary system in order to monitor new developments, follow up on requests, update management and respond to all other diary activities in a timely manner. Timely and appropriately communicate with internal and external customers relative to account trends, issues, and claim activity.
Tech Providers Inc.
$0.01
Fresno, CA
Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost-effective manner and ensuring timely issuance of disbursements. Duties:Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.
Tech Providers Inc.
$0.01
Berkeley Heights, NJ
Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost-effective manner and ensuring timely issuance of disbursements. Duties:Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.
Health Source MSO
Alhambra, CA
Responsibilities include, but not limited to: Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including:Contractual agreement rates. Job Description: Claims Auditor will be responsible for auditing claims processed by Claims Examiners.
Penske Truck Leasing Co., L.P.
Breinigsville, PA
Willingness to travel as necessary, work the required schedule, work at the specific location required, complete Penske employment application, submit to a background investigation (to include past employment, education, and criminal history) and drug screening are required. Create and deliver training material and presentations to frontline supervisors, management, human resources, operations safety on workers’ compensation reporting, accident investigation, return to work, and accident prevention.
Jones Jones LLC
$50000 - $70000
NEW YORK, NY
With decades of industry experience, we proudly serve clients through our affiliated entities - NYTIC, Emerald, Mediation Resolution Management, and Medical Management Group - offering innovative solutions, collaborative teamwork, and unwavering professionalism. We are seeking an experienced Claims Manager who is interested in growing and expanding their expertise across multiple entities, including NYTIC, Emerald, Mediation Resolution Management and Medical Management Group.
USAA
Colorado Springs, CO
After making a conditional offer and running a background check, if USAA is concerned about a conviction(s) that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. As a dedicated Manager, Claims Operations, you will lead and be accountable for property, and other claims operations member service employees who are responsible for serving our members, and providing appropriate solutions as they investigate, evaluate and negotiate the claim.
Elgen Staffing
$65000 - $85000
Delray Beach, FL
Our candidate of choice will examine foreclosure title reports and abstracted documents for evaluation of effect on the chain of title and subsequent foreclosure action and search public records to determine legal condition of property title and requirements needed to cure defective title. Our client, a prestigious, nationwide, law firm dedicated to providing legal services to financial institutions, has an immediate need for an experienced Title Examiner, to join their winning team in Delray Beach.
Iconma
Remote, CA
Responsibilities:To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Work Environment:Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Jobot
$21 - $25
Los Angeles, CA
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Please note that this role is not patient-facing and is not suitable for PSRs, front desk staff, call center representatives, patient access coordinators, claims examiners, or clinically focused coordinators.
MedStar Health
Leonardtown, MD
Given the nature of this role, the OH Manager will be expected to have a background with proven leadership skills that demonstrate the ability to be a change agent, lead projects, connect with hospital administration to build strong internal relationships, team/staff oversight, and develop process improvement to support the daily operations of the Occupational Health teams. Collaborates with OH and outside medical providers to monitor the progress of case management in terms of established outcomes which includes the length of disability rates of injury and illness and other specific indicators.
USAA
$93770 - $179240
San Antonio, TX
Leads high exposure, high profile and critical work assignments, and special investigations involving sophisticated niche fraud referrals, (examples: organized provider rings, staged accidents, large losses of significant exposure and broad scale PIP/Casualty Schemes) across multiple entities or functions. Processes large quantities of unstructured detailed information with high levels of accuracy by collecting evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.
Berkley
$60000 - $65000
San Diego, California
Key functions include but are not limited to: Make indemnity payments to claimants, both lump sum and ongoing payments, including initial, final and retroactive periods. This position will make inquiries with claims examiners, medical providers and injured workers, as needed, to assess return to work status and determine whether further payments should be issued.
New York City Housing Authority
$120000 - $140000
Brooklyn, NY
TEEMA Group
$36 - $38
Dallas, TX
If you are a talented, experienced Claims Adjuster/Examiner with an active Texas Workers Compensation license looking for a door into a large organization submit your resume now! This position requires consistent in-office collaboration with internal staff, claimants, employers, and leadership to ensure timely and compliant claims administration.
TEEMA
$70000 - $95000
kAPOLEI, HI
This role requires frequent interaction with clients, claimants, medical providers, attorneys, vendors, nurse case managers, vocational case managers, and internal staff. At the direction of the Claims Supervisor and/or Claims Manager, the Claims Adjuster/Examiner II / III manages all aspects of workers’ compensation indemnity, medical-only, future medical, and litigated claims from inception through resolution, within established authority and company/client guidelines.
USAA
$85040 - $162550
Phoenix, AZ
Reviews investigative findings of claims identified as having confirmed elements of fraud, concealment, misrepresentation, or intentional act by evaluating the evidence to determine transfer or appropriation of claims disposition. As a dedicated SIU case manager, within defined guidelines and framework you will evaluate and conclude claims identified by SIU Investigators as having elements of fraud or an intentional act.
AmTrust Financial Services, Inc.
$23 - $28.5
South Jordan, Utah
Overview: AmTrust is a major player in the commercial P&C market and the third largest workers' compensation provider in the U.S. Our small business insurance product suite continues to expand with Cyber, BOP, Employment Practices Liability Insurance (EPLI), Package and other core coverages and capabilities, including more middle-market and large accounts. Exposed to facets like Underwriting, Loss Control, Managed Care, and SIU, Claims opens diverse career paths with technical and leadership growth—perfect for making an impact and building a lasting career.
Berkley
Scottsdale, Arizona
Proactively manages claim files from inception to closure, including identification and investigation of coverage, liability and damage issues, determination and efficient execution of an appropriate plan of action, and prompt, economical file resolution, in compliance with Department guidelines and best practices. The Claims Examiner I’s primary job function includes efficiently and effectively handling primarily basic, commercial first-party property and/or third-party general liability losses in a “paperless” environment.
TEEMA Group
$85000 - $90000
Kapolei, HI
This role handles highly complex claims and plays a critical part in ensuring compliance with state regulations, timely investigations, accurate reserving, and effective claim resolution. The position requires strong analytical judgment, excellent communication skills, and consistent collaboration with clients, claimants, vendors, legal counsel, and internal teams.
SuretyHR
Columbus, OH
The occupant is expected to freely operate the following tools and equipment: personal computer (including word processing, spreadsheet, and database programs); printer; calculator; telephone; copier; fax machine. The Workers Compensation Claims Examiner is primarily responsible for analyzing and processing complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
NavitasPartners
Austin, TX
Experience in claims operations such as group disability, employee benefits, workers’ compensation, claim management, overpayment recovery, or leave management. Gather required documentation from claimants, medical professionals, and relevant sources (quantitative review).
Blue Cross Blue Shield of Kansas
Wichita, Kansas
Ensure all necessary documentation, coding (International Classification of Diseases, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS)), and data are included and correct. A health claims examiner is responsible for reviewing, evaluating, and processing health, drug, dental and/or ancillary product claims submitted by members or providers for insurance reimbursement.
Baystate Health
$23.46 - $26.97
Springfield, MA
The Claims Examiner is responsible for providing claims production to the Claims Production Team to enable the administration of non-auto adjudicated claims which contributes to the overall success of Claims Production ensuring specific individual goals, plans, initiatives are executed and delivered in support of the team’s business strategies and objectives. • Actively pursues effective and efficient operations of their respective areas in accordance with Health New England’s Values, its Code of Conduct and the Associate Handbook, while ensuring the adequacy, adherence to and effectiveness of day-to-day business controls to meet obligations with respect to operational, compliance, and conduct.
Berkley
$60000 - $116000
San Diego, California
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Whether you’re an experienced examiner or just starting your career, you’ll play a key role in ensuring timely and fair resolution of claims in compliance with California WCAB rules and regulations.
TeemaGroup
$85000 - $95000
Kapolei, HI
This role requires frequent interaction with clients, claimants, medical providers, attorneys, vendors, nurse case managers, vocational case managers, and internal staff. At the direction of the Claims Supervisor and/or Claims Manager, the Claims Examiner II / III manages all aspects of workers’ compensation indemnity, medical-only, future medical, and litigated claims from inception through resolution, within established authority and company/client guidelines.
General Placement Service
Hicksville, NY
They seek to hire a Senior Claims Examiner to manage a book of business for casualty claims. In this role you will be a part of a company that promotes a healthy work-life balance and emphasizes a "people first" environment.
Apidel Technologies
Remote, undefined
To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Apidel Technologies
Memphis, TN
Primary purpose: To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Cottingham & Butler
Dubuque, IA
We also understand that our growth is fueled by becoming better, not bigger – growth funds investments in new resources to better serve our clients and provide the career opportunities our employees want and deserve. This position is responsible for the delivery of excellent claims service to include accurate and timely claims processing and prompt and professional communication with clients and healthcare providers.
TEEMA Group
$76000 - $85000
Irving, TX
Operating with minimal supervision, this role requires strong analytical judgment, regulatory knowledge, and a commitment to delivering timely, accurate, and compliant claim outcomes. This organization is a professional risk management and claims administration firm committed to delivering responsive, compliant, and high-quality claims services.
Partnership HealthPlan of California
Fairfield, California
Follows established PHC policies and procedures, PHC Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims. The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform.
Jobot
$100000 - $160000
Fort Wayne, IN
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Experience with AI-related inventions, cloud systems, cybersecurity, distributed systems, databases, networking, or similar software domains.
Cala Sourcing Solutions LLC
$70000 - $85000
Kapolei, HI
This role requires strong knowledge of Hawaii workers’ comp regulations and the ability to handle complex, litigated claims independently. Leading Third-Party Administrator is seeking an experienced Workers’ Compensation Claims Adjuster to manage claims from intake through resolution.
University Health
San Antonio, TX
Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making. Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.
SISCO
Dubuque, IA
We also understand that our growth is fueled by becoming better, not bigger – growth funds investments in new resources to better serve our clients and provide the career opportunities our employees want and deserve. This position is responsible for the delivery of excellent claims service to include accurate and timely claims processing and prompt and professional communication with clients and healthcare providers.
Berkley
$75000 - $88000
Minneapolis, Minnesota
Responsibilities: Responsible for managing a caseload consisting of incoming and more complex workers’ compensation cases including extended disability cases, litigation, employer’s liability claims, and assigned claims. Experience must include litigation, subrogation and complex medical/legal issues or two years post-high school education and five years’ experience in workers compensation claims management.
Crum & Forster
Phoenix, Arizona
Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community.
Berkley
$90000 - $140000
Jersey City, New Jersey
We provide a comprehensive portfolio of commercial property casualty insurance, automobile liability and workers’ compensation, along with claim services, providing expertise to meet the unique business needs of our customers. Responsibilities: The Senior Claims Examiner will be responsible for reviewing, processing, investigating, evaluating, negotiating and the settling of assigned property damage or bodily injury claims with the authority level generally up to $100,000.00.
Apidel Technologies
Marlton, NJ
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking. Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations.
TEEMA GROUP
$35 - $38
Irving, TX
The ideal candidate will have strong expertise handling Texas Workers’ Compensation indemnity claims and the ability to manage claims from inception through resolution with minimal supervision. If you are an experienced Texas Workers’ Compensation Claims Examiner looking for an opportunity to contribute your expertise in a fast-paced claims environment, we encourage you to apply today.
DOCTORS HEALTHCARE PLANS, INC.
Coral Gables, FL
Position Purpose: The Claims Examiner is responsible for providing expertise and/or claims support in reviewing, researching, investigating, processing and adjusting claims and other duties as necessary. Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients.
Winston Resource LLC
$35 - $43
Stony Brook, NY
Reconcile monthly results by analyzing and comparing financial operational data, preparing monthly business performance management reports, and coordinating business reviews. Researching monthly financial results and compensation data to provide the business with key performance and financial metrics related to sales associate performance.
Gallagher
Torrance, California
The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. Behaviors: Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.