Workers Compensation Claims Examiner II

Bankers Financial Corp•St. Petersburg, FL

112d

About The Position

The Workers Compensation Claims Examiner II is a highly skilled professional responsible for managing complex and high-exposure workers’ compensation claims, ensuring strategic resolution and optimal cost management. This role serves as the escalation point for claims requiring advanced expertise while maintaining a consultative role in quarterly reporting, risk mitigation, and client advisement. Unlike traditional managerial positions, this role does not include direct supervisory responsibilities but remains integral in enhancing claims processes, mentoring claims staff, and streamlining communication between key stakeholders.

Requirements

3 to 5 years of experience in multi-state workers' compensation claims management with a PEO, insurance carrier, or brokerage.
Strong expertise in claims litigation, financial reserving, medical management, and return-to-work programs.
Proven ability to synthesize claims data into strategic risk management insights.
Strategic thinker with the ability to balance thorough investigation with efficient execution.
Strong interpersonal skills to build relationships with claims adjusters, defense counsel, and client companies.

Nice To Haves

Bachelor’s degree in risk management, business, or related field.
Advanced claims certifications (e.g., AIC, ARM, CPCU) preferred.

Responsibilities

Claims Escalation & Complex Case Resolution
Serve as the lead consultant for high-exposure, litigated, and complex claims that exceed examiner authority. Manages a book of high-exposure claims (> $100K in open reserves).
Analyze coverage, liability, and damages to recommend optimal settlement strategies.
Work closely with defense counsel, adjusters, DHR Claims Examiners, and third-party administrators (TPAs) to mitigate risk.
Provide expert recommendations on reserving strategies to ensure financial accuracy.
Client & Stakeholder Communication
Consult with internal teams and clients to optimize employer-level claim investigations and mitigation strategies.
Communicate concise, data-driven insights to clients, ensuring clarity in claim development and financial impact.
Serve as a liaison between claims adjusters, risk management, and loss prevention teams to facilitate improved outcomes.
Data Analysis & Strategic Reporting
Conduct monthly and quarterly trend analysis to identify emerging risks, cost drivers, and loss trends.
Utilize industry benchmarks and analytics tools to develop data-driven claims strategies.
Contribute to organizational risk management efforts by presenting actionable insights to senior leadership.
Process Improvement & Operational Efficiency
Assist in standardizing claims documentation, reporting, and tracking methodologies.
Provide mentorship and subject-matter expertise to claims examiners while ensuring best practices in claims handling.