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DecisionHR · 2 months ago

Workers Compensation Claims Examiner II

St. Petersburg, FL

Full-time

Onsite

Mid, Senior Level

3+ years exp

DecisionHR is a Professional Employer Organization (PEO) located in St Petersburg, FL, providing industry-leading human resource solutions. The Workers Compensation Claims Examiner II is responsible for managing complex and high-exposure workers’ compensation claims, serving as a consultant for claims requiring advanced expertise while enhancing claims processes and mentoring staff.

ComplianceEmployee BenefitsFinancial ServicesHuman ResourcesRisk Management

Responsibilities

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

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

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

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

Qualification

Workers' compensation claims managementClaims litigationFinancial reservingData analysisRisk managementAdvanced claims certificationsInterpersonal skillsStrategic thinking