Claims Examiner III

Compensation

$80,000–$90,000 annually

Hybrid

Denver, CO

Overview

We're partnering with a respected third-party administrator (TPA) specializing in workers' compensation claims to identify an experienced Claims Examiner III. This is an excellent opportunity for a seasoned workers' compensation professional who thrives in a fast-paced environment, enjoys managing complex indemnity claims, and is committed to delivering exceptional service to clients and injured workers.

In this role, you'll independently manage a caseload of complex workers' compensation claims from inception through resolution while working in a collaborative claims environment that values quality claim handling, customer service, and professional growth.

Key Responsibilities

• Independently manage an average caseload of approximately 130 workers' compensation indemnity claims, including highly complex files.
• Investigate claims promptly to determine compensability in accordance with state workers' compensation laws and company guidelines.
• Administer indemnity benefits and manage claims from inception through resolution.
• Develop and execute strategic action plans to ensure timely claim resolution.
• Coordinate and authorize appropriate medical treatment and medical billing.
• Establish and maintain accurate claim reserves within assigned authority.
• Refer claims to defense counsel when appropriate and oversee litigation strategy.
• Manage claim recoveries, including subrogation and deductible recoveries.
• Communicate effectively with claimants, employers, attorneys, medical providers, vendors, and clients regarding claim status and resolution.
• Maintain thorough claim documentation and diary management to ensure timely file activity.
• Conduct independent file reviews while maintaining compliance with internal policies and applicable regulations.
• Partner with clients to identify injury trends and workplace safety opportunities when appropriate.
• Perform additional duties as assigned.

Qualifications

Required

• Minimum 5 years of workers' compensation claims handling experience.
• Demonstrated ability to independently manage complex indemnity claims from inception through resolution.
• Strong knowledge of workers' compensation statutes, regulations, and medical terminology.
• Excellent analytical, organizational, negotiation, and decision-making skills.
• Strong written and verbal communication skills with the ability to interact professionally with clients, claimants, attorneys, and medical providers.
• State-required workers' compensation claims license or certification, where applicable.

Preferred

• Bachelor's degree in a related field.
• Experience handling self-insured workers' compensation claims.
• Experience handling City, County, or District workers' compensation claims.
• Proficiency with Microsoft Word and Excel.

Why This Opportunity

• Hybrid opportunity based in Denver, Colorado.
• Join a well-established workers' compensation organization with a collaborative and experienced claims team.
• Manage complex, meaningful claims while maintaining autonomy in your work.
• Opportunity to make a direct impact through exceptional claim handling and client service.
• Stable organization offering long-term career growth and professional development.

Compensation & Benefits

• Competitive salary of $80,000–$90,000, based on experience.
• Hybrid work environment.
• Comprehensive benefits package.
• Paid time off and company holidays.
• Professional development and ongoing training opportunities.
• Supportive team culture with experienced leadership.

Ready to Take the Next Step?

If you're an experienced Workers' Compensation Claims Examiner looking for a hybrid opportunity where your expertise is valued, we'd love to connect with you. Apply today to learn more about this confidential opportunity.