Senior Claim Examiner - Workers' Compensation (WC)

Location: Remote

Duration: 2-Month Contract (with High Possibility of Extension)

Position Overview:

We are seeking an experienced Senior Claim Examiner with expertise in Workers' Compensation (WC) claims. This position requires an active Oregon WC Adjuster License and a minimum of 5 years handling time-loss claims involving complex scenarios. The ideal candidate will possess strong investigative skills, independent decision-making capabilities, and a commitment to providing exceptional client service.

Key Responsibilities:

• Claim Management: Receive claim assignments, verify policy coverages, and initiate claim acknowledgements.
• Decision-Making: Exercise independent judgment to assess policy coverages, evaluate claim validity, and determine the extent of damages.
• Investigation: Conduct thorough investigations by engaging with clients, claimants, witnesses, and other relevant parties to gather necessary claim information.
• Evaluation and Negotiation: Evaluate claims, negotiate settlements, and adjudicate first and third-party claims in compliance with company policies.
• Reserve Management: Establish and adjust reserves based on case evaluations and authorize claim payments within assigned authority limits.
• Settlement and Disbursement: Ensure timely and equitable settlement decisions and issue payment drafts within authorized limits.
• Subrogation: Identify potential for subrogation and third-party recovery and follow applicable reclaim procedures.
• Reporting: Prepare detailed claim reports for clients, carriers, and internal management. Participate in periodic claim reviews and client meetings as needed.

Required Qualifications:

• Oregon WC Adjuster License (must provide certification upon submission of resume).
• Minimum of 5 years of experience handling time-loss claims involving complex scenarios (beyond medical-only claims).
• In-depth knowledge of Workers' Compensation regulations and procedures.
• Proven ability to handle multiple claims with varying degrees of complexity.
• Strong analytical and problem-solving skills.
• Excellent verbal and written communication skills.
• Ability to work independently and make sound decisions under pressure.

Preferred Qualifications:

• Bachelor’s degree or equivalent experience in insurance, risk management, or a related field.
• Industry certifications such as IIA, AIC, AEI, or CPCU.

Key Skills:

• Claims investigation and settlement expertise.
• Strong decision-making and critical thinking skills.
• Proficiency in preparing detailed reports and documentation.
• Exceptional negotiation and communication skills.
• Ability to handle high volumes of claims efficiently and accurately.