Sr. Claims Examiner

Acrisure•Chandler, AZ

3d•Onsite

About The Position

The Senior Workers Compensation Claims Adjuster manages workers’ compensation claims from investigation through resolution, focusing on medical-only claims and some indemnity exposure. The role evaluates compensability and liability, monitors medical treatment and return-to-work activity, and works directly with clients, employers, injured workers, physicians, attorneys, and defense counsel to move claims toward timely resolution. Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.

Requirements

3+ years of workers’ compensation claims handling experience, or an equivalent combination of training, education, and experience.
Arizona adjuster license.
Experience evaluating workers’ compensation claims, including compensability, exposure, reserves, medical treatment, and claim resolution.
Analytical and critical-thinking skills to evaluate claim information, documentation, and applicable workers’ compensation requirements.
Attention to detail when reviewing claim documentation, policies, medical information, and required filings.
Clear written and verbal communication skills and the ability to work effectively with clients, employers, claimants, medical providers, attorneys, and other involved parties.
Negotiation, organization, and time-management skills to effectively manage an active workers’ compensation caseload.
Ability to calculate figures associated with claim handling and reserves.

Nice To Haves

5+ years of workers’ compensation claims handling experience.
Multi-state adjuster licenses.
Experience working with defense counsel and the workers’ compensation litigation process.
Experience completing state filings with industrial commissions.
Experience with FileHandler.
Bilingual skills.

Responsibilities

Investigate workers’ compensation claims by gathering information from claimants, witnesses, employers, medical providers, police and hospital records, and other relevant sources.
Determine compensability and liability in accordance with applicable workers’ compensation statutes and make recommendations regarding claim coverage and direction.
Monitor medical treatment and progress, coordinate follow-up care and pre-certification when needed, and communicate work restrictions and return-to-work information to employers.
Manage claim reserves and issue medical, indemnity, legal, and expense payments based on claim exposure and supporting information.
Maintain current and accurate claim documentation, manage diary follow-ups, and review claim submissions for completeness and accuracy.
Provide clients with guidance on claim direction based on information gathered and analyzed throughout the claim lifecycle.
Coordinate with attorneys and defense counsel on litigated claims while maintaining responsibility for overall claim direction.
Complete required jurisdictional and state filings, prepare reports for excess carriers, and request reimbursement when applicable.