Claims Examiner - Claims Adjuster (Workers’ Compensation)

KEMI•Lexington, KY

About The Position

The Claims Examiner - Claims Adjuster investigates and independently manages workers’ compensation claims, determining compensability in accordance with applicable statutes, case law, and experience. The role administers medical and indemnity benefits, calculates average weekly wages, maintains claim reserves and financial documentation, and develops strategic action plans to support return-to-work goals and proactive settlement. It also involves partnering with in-house counsel when appropriate, conducting timely file reviews, managing litigation, and working toward cost-effective claim resolution. The position educates injured workers about benefits, responds to inquiries, and maintains timely, transparent communication with claimants, policyholders, and other stakeholders. It supports account retention through proactive policyholder engagement and consistent service, while meeting employee SMART Goals, following company policies, and supporting the KEMI Mission, Vision, Values, and culture. Other duties may be assigned.

Requirements

Strong organizational skills and attention to detail.
Ability to manage claims independently.
Proficient knowledge of indemnity claims.
Knowledge of medical terminology.
Strong analytical and sound decision-making skills.
Effective written and verbal communication skills.
Intermediate knowledge of Microsoft Word, Excel, and Outlook.
Ability to learn and efficiently operate software programs and business systems and adapt to changing technology.
Ability to investigate, evaluate, and independently manage workers’ compensation claims efficiently.
Ability to work at a desk for extended periods, communicate by telephone, and operate a computer, keyboard, and mouse throughout the day.
Reliable attendance and ability to interact professionally with coworkers and existing and potential customers.
Kentucky adjuster’s license required within one year of hire.
Workers’ Recovery Professional certification required within three years of hire.

Nice To Haves

Bachelor’s degree or licensed Registered Nurse preferred.
Four years of progressive insurance experience preferred.
Associate in Claims (AIC) designation preferred.

Responsibilities

Investigate claims and determine compensability in accordance with applicable statutes, case law, and experience.
Administer medical benefits in accordance with state statutes and regulations, ensuring treatment is work-related, medically necessary, and appropriate.
Calculate injured workers’ average weekly wages and initiate indemnity benefits accurately and promptly.
Maintain appropriate claim reserves and ensure financial documentation reflects current and projected case valuations.
Develop and execute strategic action plans focused on return-to-work goals and proactive settlement.
Partner with in-house counsel to use cost-effective annuities and Medicare Set-Asides when appropriate.
Conduct comprehensive, timely file reviews and document claim strategy, reserves, and resolution paths.
Educate injured workers about benefits and respond to inquiries promptly and accurately.
Engage proactively with policyholders to support account retention and customer satisfaction.
Communicate transparently and promptly with stakeholders to support alignment and proactive claim resolution.
Actively manage litigation and pursue timely, cost-effective claim resolution.
Achieve employee SMART Goals and perform other duties as requested.
Adhere to company policies, maintain reliable attendance, interact professionally with coworkers and customers, and support the KEMI Mission, Vision, Values, and culture.