Workers Compensation Claims Examiner Job at Robert Half (Alpharetta)

Claims Examiner - Workers Compensation

We are looking for a skilled Claims Examiner specializing in Workers Compensatio...

Location

United States , Alpharetta

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Active Adjuster’s license to handle Workers Compensation claims, or the ability to obtain one immediately upon starting employment
Minimum of three years of experience in Workers Compensation claim handling
Bachelor’s degree or equivalent relevant experience preferred
Proven ability to evaluate, analyze, and interpret complex information
Strong organizational skills and ability to manage multiple tasks effectively
Excellent verbal and written communication skills
Demonstrated critical thinking and decision-making abilities
Experience working collaboratively in team environments

Job Responsibility

Manage and investigate Workers Compensation claims, ensuring compliance with established procedures and regulations
Deliver outstanding customer service to insureds, claimants, agents, and other stakeholders through clear and effective communication
Accurately assess expenses and losses related to Lost Time claims, providing timely and detailed reports
Identify and address coverage issues, potential fraud, and subrogation opportunities while adhering to company guidelines
Develop and execute effective claim strategies to achieve early resolutions and positive outcomes
Maintain organized and up-to-date files using a diary system to monitor progress and follow up on new developments
Communicate trends, issues, and claim activities to internal and external customers in a timely manner
Collaborate with team members to ensure claims are managed and resolved effectively
Provide guidance and direction to colleagues to facilitate efficient claim processing and resolution

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Claims Examiner – Workers’ Compensation

This Workers’ Compensation Claims Examiner role requires an analytical, detail‑o...

Location

United States , Alpharetta

Salary:

30.00 - 31.00 USD / Hour

Robert Half

Expiration Date

Until further notice

Requirements

Must hold a valid adjuster's license to manage Workers Compensation claims or obtain one promptly after starting employment
A minimum of 3 years of experience handling Workers Compensation claims is required
Strong analytical skills with the ability to evaluate and interpret complex information effectively
Excellent organizational and time management skills, with the ability to handle multiple tasks simultaneously
Proven ability to work collaboratively in team settings and maintain positive working relationships
Exceptional verbal and written communication skills to convey information clearly and effectively
Bachelor's degree or equivalent detail-oriented experience is preferred
Commitment to delivering superior performance and customer satisfaction
Current Georgia Workers’ Compensation Adjuster License (required)
Additional licenses: Florida, South Carolina, North Carolina (strong plus)

Job Responsibility

Provide accurate and timely assessments of Workers’ Compensation Lost Time claims
Conduct thorough investigations, evaluate coverage, assess loss exposure, and manage cases according to established guidelines
Identify and appropriately address potential fraud, subrogation opportunities, and coverage concerns
Establish and execute effective case strategies to ensure timely and appropriate claim resolution
Deliver superior customer service to insureds, claimants, agents, underwriters, and internal partners
Communicate timely updates regarding claim activity, trends, and issue escalation
Maintain professional and effective interactions with all stakeholders
Ensure all claim files are up‑to‑date using a consistent diary system to monitor developments, follow‑ups, and required actions
Maintain accurate documentation aligned with regulatory requirements and internal quality standards
Achieve consistent compliance in investigation, coverage evaluation, loss assessment, and case management practices

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Fulltime

Workers’ Compensation Claim Examiner

Location

United States , New Haven

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

3+ years of Workers’ Compensation Claim Examiner experience or commensurate transferable experience
Direct workers’ compensation experience is preferred but not required, provided transferable claims skills are present
Experience working in a fast‑paced, customer‑focused environment
Strong verbal, written, and telephonic communication skills
Prior roles requiring high levels of organization, follow‑up, and accountability
Proficiency with Microsoft Office products
Claim Adjuster licenses in Connecticut, New Hampshire, Rhode Island, and Vermont are required but not necessary at the time of posting
If not currently licensed, the selected candidate will be required to obtain an applicable resident or designated home‑state adjuster license and any required additional state licenses

Job Responsibility

Handle all aspects of workers’ compensation claims from inception to closure while maintaining strong customer relations
Review claim and policy information to establish investigative background
Conduct ongoing three‑part investigations, including fact‑finding and statement collection from insureds, claimants, and medical providers
Evaluate investigation findings to determine claim compensability
Notify insureds, claimants, and attorneys of claim denials when applicable
Prepare investigative reports, settlements, denials, and evaluations of involved parties
Administer statutory medical and/or indemnity benefits accurately and timely throughout the life of the claim
Set medical, indemnity, and expense reserves within authority limits and recommend reserve changes to the Team Leader as needed
Perform regular claim reviews and recommend corrective or remedial actions to address issues
Identify and escalate unusual or potentially adverse exposures to leadership

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Claims Examiner

We are seeking a detail-oriented Claims Examiner to join a fast-paced, customer-...

Location

United States , New Haven

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

3+ years of Claims Examiner experience or related transferable experience
Knowledge of workers’ compensation regulations (preferred but not required)
Excellent analytical and problem-solving skills
Strong communication (verbal and written) abilities
Ability to manage multiple priorities and meet deadlines
High attention to detail and organizational skills
Proficiency in Microsoft Office
Ability to collaborate effectively with cross-functional teams
Commitment to delivering high-quality customer service

Job Responsibility

Manage workers’ compensation claims from setup through closure
Review claim and policy information to support investigations
Conduct thorough investigations, including gathering statements from claimants, insured parties, and medical providers
Determine claim compensability based on collected facts
Communicate claim decisions, including denials, to relevant stakeholders
Prepare detailed reports on investigations, settlements, and claim evaluations
Administer statutory medical and indemnity benefits in a timely manner
Set and adjust reserves within authority limits and recommend changes as needed
Monitor claim progress and recommend corrective actions to leadership
Coordinate with attorneys on hearings and litigation

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Fulltime

Personal Injury Protection Claims Examiner

We are looking for Personal Injury Protection (PIP) Claims Examiners in our Tamp...

Location

United States , Tampa

Salary:

47150.00 - 72775.00 USD / Year

Geico

Expiration Date

Until further notice

Requirements

Bachelor’s degree preferred
Prior insurance claims experience preferred, but not required
Personal injury, bodily injury or workers’ compensation experience preferred
Solid analytical, customer service and multi-tasking skills
Strong attention to detail, time management and decision-making skills

Job Responsibility

Investigate medical necessity and determine casualty
Consult with involved parties, secure medical information and review insurance contracts, associated reports and billing documentation
Evaluate the validity of personal injury insurance claims and monitor case files over the course of treatment

What we offer

Comprehensive Total Rewards program
401K savings plan with a 6% match
Performance and recognition-based incentives
Tuition assistance
Access to mental healthcare as well as fertility and adoption assistance
Workplace flexibility
GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year

Fulltime

Sr. Customer Service Representative

We are looking for a detail-oriented individual to support workers’ compensation...

Location

United States , Atlanta

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience handling workers’ compensation claims with a strong understanding of claim lifecycle management and resolution practices
Knowledge of Georgia workers’ compensation rules, reporting obligations, and payment requirements
Ability to investigate claims, interpret documentation, and make sound decisions based on available facts
Skill in preparing clear written reports, recommendations, and claim-related correspondence
Proficiency in claims processing, claims data review, and use of claims management or claims edit systems
Strong communication skills for working effectively with employees, supervisors, medical providers, attorneys, and regulatory contacts
High attention to detail with the ability to maintain organized records and manage multiple deadlines in a fast-paced environment

Job Responsibility

Manage workers’ compensation cases from intake through resolution, applying Georgia regulations and established claim practices throughout the process
Examine claim details, incident information, and supporting documentation to determine appropriate next steps and claim direction
Produce clear written summaries, recommendations, and status updates that capture findings and support informed decision-making
Coordinate with injured employees, leaders, physicians, rehabilitation specialists, and state workers’ compensation contacts to facilitate recovery and return-to-work planning
Oversee the timely handling of medical and wage-related payments, while maintaining accurate files and submitting required state reporting within deadlines
Complete daily administrative activities such as opening new claims, reviewing incident materials, and updating claim records
Partner with legal counsel by supplying claim information, documentation, and case support for matters involving litigation
Identify recovery opportunities, including subrogation and applicable trust fund matters, and pursue them within required timeframes
Provide additional operational support as needed, including related assignments that assist broader departmental or field activities

What we offer

medical, vision, dental, and life and disability insurance
enrollment in company 401(k) plan

Fulltime

Payment Poster Specialist

We are looking for a Payment Poster Specialist to join an organization in Glen B...

Location

United States , Glen Burnie

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 2 years of experience in medical payment posting or a closely related healthcare reimbursement role
Hands-on experience working with Workers’ Compensation claims and payment processes
Familiarity with billing practices and reimbursement terminology
Ability to interpret explanation of benefits statements, remittance advice, and payer payment details
Knowledge of fee schedules and the ability to recognize underpayments, denials, and reimbursement discrepancies
Strong attention to detail with the ability to manage multiple accounts accurately in a fast-paced setting
Proficiency with healthcare billing systems and standard payment posting workflows

Job Responsibility

Record and apply insurance and patient payments accurately to the appropriate accounts within established timelines
Review explanation of benefits documents and remittance details to confirm payment accuracy and identify issues requiring follow-up
Reconcile posted transactions against account balances to ensure reimbursement records are complete and correct
Examine Workers’ Compensation payments against applicable fee schedules to detect variances, underpayments, or denials
Escalate reimbursement discrepancies and unresolved claim issues to the appropriate team members for further action
Maintain thorough and organized documentation of posting activity, account adjustments, and payment-related exceptions
Support high-volume payment workflows while preserving accuracy, consistency, and compliance with billing standards

What we offer

Medical
Vision
Dental
Life insurance
Disability insurance
401(k) plan
Free online training

Fulltime

Claims Assistant

We are looking for a detail-oriented Claims Assistant to support claims operatio...

Location

United States , Reno

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

3+ years of experience in claims support, administrative assistance, or a related office-based role
Hands-on knowledge of workers' compensation claims processing and benefit administration
Ability to perform accurate data entry and maintain detailed documentation in a fast-paced environment
Experience handling inbound calls and providing attentive customer support to a variety of stakeholders
Working understanding of basic medical terminology relevant to injury-related claims
Strong organizational skills with the ability to prioritize multiple tasks and follow deadlines
Clear written and verbal communication skills for interacting with internal teams and external contacts

Job Responsibility

Review claim information, assess supporting details, and help establish appropriate reserves based on injury information, expected costs, and claim circumstances
Deliver attentive service to internal teams, claimants, employers, medical providers, and other partners through consistent and timely communication
Process benefits accurately in alignment with applicable regulations and company standards, including preparation and submission of required state documentation
Coordinate medical treatment activity and track claim progress to help keep files moving efficiently toward resolution
Use available internal and external resources to support cost control efforts and reduce claim exposure where appropriate
Examine claim files for potential legal concerns, work with attorneys as needed, and support settlement evaluation within established authority levels
Maintain organized claim records through careful data entry, documentation review, and ongoing administrative support
Manage inbound calls and respond to routine inquiries related to claim status, required forms, and next steps
Conduct regular reviews of assigned files to identify updates, outstanding items, and opportunities to advance claim handling

What we offer

Medical, vision, dental, and life and disability insurance
401(k) plan

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Workers Compensation Claims Examiner

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