Job Title: Senior Claims Examiner
Location: Richmond, VA 23219
Duration: 4+ Months (Possibility of extension depending upon business requirements and performance)
 
Job Summary:

• The Claims Examiner Senior investigates, and processes Workers’ Compensation claims for company employees.
• In addition to or in lieu of Workers’ Compensation claims, the Claims Examiner Senior may manage general liability, auto liability or property/casualty claims from low to high complexity and may serve liaison/point of contact for claims adjusters handling commercially insured losses/claims for company.
• This job assists in the coordination of an effective commercial insurance and self-insured Workers’ Compensation Claim Program that is compliant with state laws and meets the needs of company.
• This job is responsible for handling assigned claims appropriately and in a timely and fair manner.
• This job manages subrogation of claims and negotiating settlements.
• This job maintains effective communication with claimants/injured employees, medical staff (treating physicians), employee supervisors, outside counsel, and all other internal and external stakeholders as appropriate.
• This job manages high complexity Workers’ Compensation claims with a total dollar value in excess of (USD)2 million.
• This job must fully understand and comply with Virginia Workers’ Compensation laws.

 
Responsibilities:

• Reviews, investigates, and evaluates all work-related occupational injury claims in a timely and efficient manner.
• Gathers independent investigative information and interviews witnesses.
• Takes statements, photos, and measurements and preserves evidence.
• Generates and files FROIs and SROIs with the Virginia Workers’ Compensation Commission.
• Ensures compensability determinations, establishes claim reserves, and processes medical and indemnity payments in accordance with the Virginia Workers’ Compensation Act.
• Coordinates with Employee Health Services and the Security and Safety Department to investigate claims and identify opportunities to make the work environment safer.
• Complies with the law, rules and procedures as outlined in the Virginia Workers’ Compensation Act.
• Evaluates and settles claims and attends trials, depositions, and testifies as appropriate.
• If assigned, reviews and evaluates general liability, auto liability, and property/casualty claims of varying complexity and negotiates settlements with AVP/Director approval.
• If assigned, serves as liaison for adjusters and Risk Management staff handling commercially insured losses for company.
• Obtains and evaluates medical records to determine appropriate care and develops treatment plans for injured employees.
• Coordinates with physicians to support transitional duty or return-to-work plans.
• Develops transitional duty assignments and may process complex lifetime or defined-period medical claims.
• Communicates professionally with internal and external stakeholders including employees, supervisors, Employee Health Services, Payroll, HR, vendors, and counsel.
• Accurately documents claim facts, compensability, payments, vendor usage, and all actions taken toward claim resolution.
• Manages litigation and external vendor relationships including attorneys, medical and vocational staff, and investigative vendors.
• Provides clear direction to vendors and ensures coordinated claim plans.
• Assists with other claim activities including bill negotiations, risk assessments, surveys, OSHA filings, and insurance renewal processes.
• Demonstrates accountability for safety and supports high-reliability organizational practices.
• Supports diversity, equity, and inclusion initiatives across the health system.

 
Skills:

• Minimum of seven (7) years of progressively responsible Workers’ Compensation claims adjudication or equivalent claims handling experience.
• Previous experience with Microsoft Office applications.
• Previous negotiation skills.
• Ability to determine acceptance and/or compensability of claims including investigation, evaluation, settlement, and reserve establishment.
• Ability to authorize payments within authority and develop recommendations for leadership.
• Skill in performing medical management on Workers’ Compensation claims and serving as Return-to-Work liaison for company.
• Ability to manage litigation and high-complexity claims.
• Analyzes claims to identify opportunities to improve workplace safety and partners with company Employee Health, company Safety and Security Department, injury prevention specialists, and supervisors to address workplace safety concerns.
• Ability to provide oversight or claim support during off-hours serious incidents if available which may include returning to the affected site and/or coordinating with broker, independent adjuster, claim staff, other company staff, and/or emergency personnel from a remote location.
• Strong recall, reasoning, problem-solving, hearing, clear speaking, legible writing, reading, and logical thinking abilities.
• Ability to maintain steady pace, handle multiple priorities, interact with customers, and adapt to frequent change.

 
Preferred Skills & Experience:

• Previous lead or supervisory experience.
• Claim handling experience including general liability, auto liability, and/or property and casualty lines.
• Previous work experience in a risk management or legal setting.

 
Education
Required Education:

• High school diploma or GED.

 
Preferred Education:

• Associate’s degree in Business, Finance, or closely related field.

OR

• Bachelor’s degree in Business, Finance, or closely related field.

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 38.96/hr.