Workers Compensation Claims Examiner- NM (Hybrid)

Workers' Compensation Claims Examiner III — Albuquerque, New Mexico

Hybrid
Salary: Up to $90,000/year

Our client, a national third-party administrator specializing in risk management and claims services, is hiring a Workers' Compensation Claims Examiner III to join their Albuquerque branch operations team.

This is a senior-level desk built for an examiner who can run complex indemnity files independently. You'll manage a caseload from inception through resolution under minimal supervision, working directly with clients, claimants, medical providers, defense counsel, and vendors. If you're an experienced examiner who wants ownership of your file strategy rather than someone else's checklist, this is a strong fit.

What You'll Do

• Manage an average caseload of approximately 130 workers' compensation files, including highly complex claims
• Initiate and conduct timely investigations, and determine compensability based on state law and established guidelines
• Develop and execute well-structured action plans that drive each claim to an appropriate and timely resolution
• Manage medical treatment and medical billing, authorizing care as appropriate
• Calculate and issue benefit payments, and approve all claim payments within designated authority
• Compute and set reserves within company guidelines
• Refer files to outside defense counsel and direct litigation strategy
• Pursue claim recoveries of all types, including deductible and subrogation
• Maintain a disciplined diary system, document file activity, and conduct file reviews independently
• Communicate proactively with clients on claim status, injury trends, and safety-related concerns

What You'll Need

• Five (5) or more years of workers' compensation claims experience, or an equivalent combination of education and experience
• Bachelor's degree in a related field (preferred)
• Technical command of statutory regulations and medical terminology
• Proven ability to independently manage very complex indemnity claims
• Excellent written and verbal communication skills, including the ability to translate technical detail for claimants, clients, and internal staff
• Strong analytical skills and sound, defensible decision-making
• Any certifications or licenses required by state regulation
• Proficiency in Word and Excel (preferred)
• Self-insured claims handling experience (preferred)
• City, county, and/or district (public entity) claims experience (preferred)

Why This Role

• Senior-level autonomy with real settlement and reserve authority
• Established national platform with defined career progression
• Direct reporting line to a Claims Supervisor — flat, accessible structure
• Full benefits package