Claims Examiner Jobs in the United States

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.

Vaco LLC

$55000 - $65000

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.

Mercury Insurance Services, LLC

$76829 - $142213

Remote, undefined

Be able to seamlessly transition between various methods of inspection, including video, or photo, to write a damage estimate: • Possess strong organizational, time management, and prioritization skills to handle varying workloads due to seasonal volume changes and catastrophes. Upon completion of the training program, ideal candidates will transition into a property claims Examiner adjusting position, collaborating with vendors, and/or virtually inspecting and estimating losses damaged by fire, water, weather, or other unexpected events.

Fallon Health

Worcester, MA

Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality.

Premier Administrative Solutions

Clearwater, Florida

While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. Initiates and completes claim investigations when indicated including pre-existing conditions, accidents, medical necessity and appropriateness, eligibility and coordination of benefits.

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.

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.

AmTrust Financial Services, Inc.

$44 - $54

Irvine, California

Responsibilities: Investigates the claim or coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured or employer representatives, claimants or injured workers, witnesses and producers. Depending on the type of claim may:Communicate with internal Managed Care and Medical resources to ensure coordination with Medical providers on the development and authorization of appropriate treatment plans as well as accurate billing.

AmTrust Financial Services, Inc.

$53300 - $72000

Scottsdale, Arizona

Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. Overview: AmTrust Financial Services is growing fast and looking for a Claims Examiner I to join our Workers’ Compensation team.

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.

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.

Berkley

$85000 - $120000

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. 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.

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.

CHRISTUS Health

Irving, TX

Serves as a resource to assist with training new associates, retraining current associates on new/updated desktops/policies and reports staff progress, deficiencies, and training needs to management. This role works in conjunction with Business Configuration, Network Management, Provider Data, Complaints, Appeals and Grievances as well as other operational departments to ensure validation and quality assurance of claims processing.

Apidel Technologies

Memphis, TN

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.

Apidel Technologies

Pasadena, CA

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.

MagnaCare

Melville, NY

Assist Customer Service, Casualty, Medical Management, and Management teams by providing support in resolving claims and responding to questions and concerns. Excellent analytical and problem-solving skills, with the ability to identify discrepancies and resolve complex claim issues.

American International Group

Jeffersonville, IN

AIG Warranty delivers a full range of service solutions including warranty management administration, extended service contracts and mobile insurance theft/loss programs, customer service support, service network management, claims processing services, and service contract underwriting. Claims Examiners are responsible for receiving incoming calls and emails from Service Providers needing authorization for repairs on major appliances, consumer electronics, heating and air, or other home systems.

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.

Mississippi Employer

$32032 - $35000

Gulfport, MS

JOB OBJECTIVE: The purpose of this position is to receive and maintain purchase transaction forms generated by the County procurement system by conducting detailed analysis of all transactions, vendor claim documents, and procurement documents. Follow purchases from beginning to end to ensure vendors are paid in a timely manner and making sure only items received are paid for.

TeemaGroup

$36 - $38.46

Irving, TX

This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position. Education/Experience: High School Diploma or GED required; Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.

Apidel Technologies

Eden Prairie, MN

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. 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.

Consociate Health

Remote, RMT

As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients. Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.

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.

Veterans Sourcing Group

Olathe, KS

Confirm coverage of claims (accident and sickness claims, hospital cash claims, out of country medical and business-related travel claims) by reviewing policies and documents submitted in support of claims. The Claims Examiner II Accident and Health will be responsible to handle all aspects of claim resolution for assigned claims while providing world class service to external and internal customers.

Iconma

Long Beach, CA

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. Responsibilities:Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

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.

Sedgwick

$66000 - $85000

Olympia, WA

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Liability Claims Examiner | GL & Auto - BI & PD | Nationwide Jurisdiction | License Required Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? To analyze **General Liability & Auto (Bodily Injury & Property Damage)** claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

Sedgwick

$80000 - $90000

Olympia, WA

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | Dedicated Client | NY Licensing Required | Remote Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? To analyze **New York** **Workers Compensation Lost-Time** claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

Sedgwick

$75000 - $80000

Olympia, WA

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 _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claims Examiner, Bodily Injury | Lit Required | Auto | Remote **PRIMARY PURPOSE** : To analyze and process complex auto bodily injury claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.

Lancesoft

Brea, CA

Job Description: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. OSIP certificate - Preferred .

Pima County, AZ

$22.18 - $26.05

Tucson, AZ

The successful applicant will be subject to a 39-month DOT Motor Vehicle Record review to determine applicant’s suitability to operate county vehicles in accordance with Pima County administrative procedures. The actual salary offer will carefully consider a wide range of factors, including your skills, qualifications, experience, education, licenses, training, and internal equity.

Sedgwick

$85000 - $100000

Olympia, WA

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 _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. + 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 **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations.

Sedgwick Claims Management Services, Inc.

$72300 - $101220

NY, NY

PRIMARY PURPOSE OF THE ROLE: To analyze high-level Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

Sedgwick Claims Management Services, Inc.

$70000 - $80000

Cincinnati, OH

PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. To analyze Liability Litigation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

Raphael and Associates

Rutherford, NJ

Responsibilities Provide superior claim management for first party physical damage cargo business throughout the entire claim life cycle inclusive of customer service, technical expertise, coverage analysis and claim analysis and evaluation. You will have the ability to make a meaningful impact by leveraging your claim handling skills, industry expertise, customer service skills, and ability to execute with a high degree of professionalism.

AEM Inc

Springfield, VA

This position works under general supervision while conducting customer service activities to receive, process, analyze, and resolve household goods cargo, property, and inconvenience claims and claim-related matters filed by our customers. Prepare claim settlement offers in a written format and submit them to the customer within the prescribed time allotted, while trying to consistently reduce the overall number of outstanding claims and amount spent.

DB Insurance Co., Ltd.

Great Neck, NY

In this role, you will handle claims involving third-party liability, specifically in commercial trucking and business policies, working to resolve them efficiently while ensuring fair settlements. Key Responsibilities: Investigate, evaluate, and resolve third-party claims including bodily injury, property damage, and liability claims including ones in litigation for commercial trucking and business policies.

Sedgwick

$75000 - $95000

Olympia, WA

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 _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. + 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 **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations.

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. About you: Required: Bachelor's degree with 3+ years client service and/or claims management experience -OR- High School degree/GED with 8+ years client service and/or claims management experience.

Raphael and Associates

Rutherford, NJ

You will have the ability to make a meaningful impact by leveraging your claim handling skills, industry expertise, customer service skills, and ability to execute with a high degree of professionalism. Most importantly, you will have the opportunity to work directly alongside an extraordinary and dedicated team to grow a critical function within a dynamic, growing company.

Sedgwick Claims Management Services, Inc.

$69288 - $98000

Long Beach, CA

PRIMARY PURPOSE: 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. Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

Sedgwick Claims Management Services, Inc.

$70000 - $100000

Long Beach, CA

PRIMARY PURPOSE: 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.

Sedgwick Claims Management Services, Inc.

NC, NC

PRIMARY PURPOSE: 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.

Axelon Services Corporation

Denver, CO

Work with risk managers, senior leaders, and external attorneys to review coverages, investigate claims, analyze liability and damages, establish adequate indemnity and expense reserves, develop strategies and resolve claims, including, but not limited to direct participation in mediation and arbitration and active participation in settlement discussions. " Requires advanced knowledge of claims handling concepts, practices, procedures and techniques, including, but not limited to coverage issues, product lines, marketing, computers and product competition within the marketplace.

Sedgwick

$85000 - $95000

Olympia, WA

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | NY Jurisdictional Knowledge & NY Licensing Required We are seeking a highly motivated and experienced Workers' Compensation Claims professionals to join our team. **OFFICE LOCATION** Hybrid schedule if within 25 miles of Syracuse, NY office (3 days work from home) Remote if outside of 25 miles **QUALIFICATIONS** + **Experience:** + Minimum of (2) years of workers' compensation claims handling experience.

Sedgwick

$70000 - $75000

Olympia, WA

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claims Examiner, Auto | Bodily Injury | GL | Remote **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. **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 _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings.

Cala Sourcing Solutions LLC

$36 - $38

Irving, TX

This role is ideal for an experienced examiner who is confident working independently, thrives in an in-office setting, and understands the importance of accuracy, urgency, and strong communication. We’re looking for a seasoned Workers’ Compensation Claims Examiner III to step into a fast-paced, high-volume environment and take ownership of Texas loss-time claims from start to finish.

American International Group

Lenexa, KS

Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. Confirm coverage of claims (AD&D, accident and sickness claims, critical illness, hospital cash claims, out of country medical and business-related travel claims) by reviewing policies and documents submitted in support of claims.

AmTrust Financial Services, Inc.

Latham, New York

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.