Senior Claims Examiner

2 days ago


Richmond, Virginia, United States Pride Health Full time

Job Title: Senior Claims Examiner

Location:
Richmond, VA

Start Date:
01/12/2026

End Date:
05/30/2026 (possible extension)

Shift:
Monday – Friday, 8:00 AM – 4:30 PM

Pay:
$39–$40 per hour

Overview

The Senior Claims Examiner manages
Workers' Compensation, general liability, auto liability, and property/casualty claims
, including high-complexity claims. This role investigates, evaluates, and settles claims while ensuring compliance with state laws and effective communication with all stakeholders.

Requirements

  • High School Diploma or equivalent (Associate's/Bachelor's preferred)
  • 7+ years of Workers' Compensation or claims handling experience
  • Microsoft Office proficiency
  • Strong negotiation and analytical skills
  • Preferred: Lead/supervisory experience and exposure to risk management or legal settings

Responsibilities

  • Determine claim compensability and manage claim resolution
  • Establish reserves, authorize payments, and negotiate settlements
  • Perform medical management and act as Return-To-Work liaison
  • Handle high-complexity claims and litigation as needed
  • Ensure compliance with applicable state laws

Work Environment

  • General office setting
  • Physical: Sitting, occasional lifting 0–50 lbs.
  • Mental/Emotional: Manage multiple priorities, adapt to change, strong problem-solving

Pride Health offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors


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