Senior Claim Examiner

2 days ago


Portland, United States TPI Global Solutions Full time

Senior Claim Examiner - Workers' Compensation (WC)

Location: Remote

Duration: 2-Month Contract (with High Possibility of Extension)


Position Overview:

We are seeking an experienced Senior Claim Examiner with expertise in Workers' Compensation (WC) claims. This position requires an active Oregon WC Adjuster License and a minimum of 5 years handling time-loss claims involving complex scenarios. The ideal candidate will possess strong investigative skills, independent decision-making capabilities, and a commitment to providing exceptional client service.


Key Responsibilities:

  • Claim Management: Receive claim assignments, verify policy coverages, and initiate claim acknowledgements.
  • Decision-Making: Exercise independent judgment to assess policy coverages, evaluate claim validity, and determine the extent of damages.
  • Investigation: Conduct thorough investigations by engaging with clients, claimants, witnesses, and other relevant parties to gather necessary claim information.
  • Evaluation and Negotiation: Evaluate claims, negotiate settlements, and adjudicate first and third-party claims in compliance with company policies.
  • Reserve Management: Establish and adjust reserves based on case evaluations and authorize claim payments within assigned authority limits.
  • Settlement and Disbursement: Ensure timely and equitable settlement decisions and issue payment drafts within authorized limits.
  • Subrogation: Identify potential for subrogation and third-party recovery and follow applicable reclaim procedures.
  • Reporting: Prepare detailed claim reports for clients, carriers, and internal management. Participate in periodic claim reviews and client meetings as needed.


Required Qualifications:

  • Oregon WC Adjuster License (must provide certification upon submission of resume).
  • Minimum of 5 years of experience handling time-loss claims involving complex scenarios (beyond medical-only claims).
  • In-depth knowledge of Workers' Compensation regulations and procedures.
  • Proven ability to handle multiple claims with varying degrees of complexity.
  • Strong analytical and problem-solving skills.
  • Excellent verbal and written communication skills.
  • Ability to work independently and make sound decisions under pressure.


Preferred Qualifications:

  • Bachelor’s degree or equivalent experience in insurance, risk management, or a related field.
  • Industry certifications such as IIA, AIC, AEI, or CPCU.


Key Skills:

  • Claims investigation and settlement expertise.
  • Strong decision-making and critical thinking skills.
  • Proficiency in preparing detailed reports and documentation.
  • Exceptional negotiation and communication skills.
  • Ability to handle high volumes of claims efficiently and accurately.



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