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Complex Claims Examiner Jobs (NOW HIRING)

Martins Investment Group

Claims Examiner III

Fresno, CA · Hybrid

$80K - $83K/yr

Claims Examiner III Workers? Compensation$80K $83K + BenefitsHybrid Remote | Fresno, CA (2 days per ... Manage complex, litigated, and non-disabling Workers? Compensation claims from inception through ...

Hiscox

Senior Claims Examiner - Property

New York, NY · Hybrid

Senior Claims Examiner- 1st Party Property Team: 1st Party Property Band: II The Role: The Senior ... Adjusts and resolves moderate to complex claims that includes all phases 1st Party commercial ...

LIO Insurance

Claims Examiner (Casualty)

Conshohocken, PA · On-site +1

$68.42K - $123.31K/yr

The Claims Examiner - Casualty is accountable for managing a portfolio of moderate complexity ... S platforms, applying sound judgment and seeking guidance on complex or high-exposure matters

LIO Insurance

Claims Examiner (Casualty)

Richmond, VA · On-site +1

$68.42K - $123.31K/yr

The Claims Examiner - Casualty is accountable for managing a portfolio of moderate complexity ... S platforms, applying sound judgment and seeking guidance on complex or high-exposure matters

Hiscox

Senior Claims Examiner - Property

Boston, MA · Hybrid

Senior Claims Examiner- 1st Party Property Team: 1st Party Property Band: II The Role: The Senior ... Adjusts and resolves moderate to complex claims that includes all phases 1st Party commercial ...

Hiscox

Senior Claims Examiner - Property

Atlanta, GA · Hybrid

Senior Claims Examiner- 1st Party Property Team: 1st Party Property Band: II The Role: The Senior ... Adjusts and resolves moderate to complex claims that includes all phases 1st Party commercial ...

Hiscox

Senior Claims Examiner - Property

Chicago, IL · Hybrid

Senior Claims Examiner- 1st Party Property Team: 1st Party Property Band: II The Role: The Senior ... Adjusts and resolves moderate to complex claims that includes all phases 1st Party commercial ...

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How much do complex claims examiner jobs pay per hour?

As of May 29, 2026, the average hourly pay for complex claims examiner in the United States is $29.40, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $35.10 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Complex Claims Examiner, and why are they important?

To thrive as a Complex Claims Examiner, you need advanced knowledge of insurance policies, legal regulations, and claims investigation, typically supported by a bachelor's degree and relevant industry experience. Familiarity with claims management software, data analysis tools, and sometimes certifications like AIC (Associate in Claims) are often required. Strong analytical thinking, attention to detail, and effective communication are standout soft skills in this role. These skills ensure accurate claim assessments, mitigate risk for the organization, and foster trust with clients and stakeholders.

What are some typical challenges a Complex Claims Examiner faces when handling intricate cases?

Complex Claims Examiners often deal with multifaceted cases that require in-depth analysis, thorough documentation review, and coordination with multiple stakeholders such as legal teams, medical professionals, and policyholders. One common challenge is interpreting ambiguous policy language and making fair determinations while remaining compliant with regulations. Additionally, managing high caseloads and tight deadlines can be demanding, so strong organizational and communication skills are essential. Successfully navigating these challenges helps build expertise and prepares examiners for future advancement within claims management.

What are Complex Claims Examiners?

Complex Claims Examiners are professionals who review, analyze, and process insurance claims that involve complicated circumstances, high-value losses, or ambiguous policy interpretations. They investigate claims by gathering evidence, interviewing involved parties, and consulting policy documents to determine the validity and extent of the insurer’s liability. These examiners work closely with legal teams, medical experts, or other specialists as needed to resolve claims efficiently and fairly. Their role is crucial in ensuring that claims are handled accurately while minimizing fraud and ensuring compliance with regulations.

What is the difference between Complex Claims Examiner vs Claims Adjuster?

AspectComplex Claims ExaminerClaims Adjuster
Required CredentialsInsurance license, sometimes certifications like CPCU or AICInsurance license, often similar certifications
Work EnvironmentInsurance companies, claims departmentsInsurance companies, independent agencies, or third-party administrators
Job FocusEvaluating complex or high-value claims, detailed analysisInvestigating, negotiating, and settling claims

The Complex Claims Examiner specializes in reviewing and analyzing complex or high-value insurance claims, often requiring detailed assessments and specialized knowledge. Claims Adjusters handle a broader range of claims, including simpler cases, focusing on investigation and settlement. While both roles require insurance licensing and similar certifications, the Complex Claims Examiner typically deals with more intricate cases within insurance companies' claims departments.

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Complex Claims Examiner jobs near you

Claims Examiner III

Martins Investment Group

Fresno, CA • Hybrid

$80K - $83K/yr

Full-time

Medical, Dental, Vision, PTO

Posted 5 days ago

Job description

Claims Examiner III Workers? Compensation$80K $83K + BenefitsHybrid Remote | Fresno, CA (2 days per week onsite)This role is ideal for a strong claims professional who enjoys handling challenging files, working independently, and supporting operational excellence across multiple claim assignments and jurisdictions.At the Direction of the Claims Supervisor, and/or Manager and under minimal supervision manages all aspects of litigated indemnity claims handling from inception to conclusion within established authority and guidelines.This position requires considerable interaction with clients, claimants, medical providers,Attorneys, vendors, Nurse and Vocational Case Managers, and other company staff.Essential Responsibilities:Manage complex, litigated, and non-disabling Workers? Compensation claims from inception through resolutionConduct timely investigations and determine claim compensability based on state regulations and company guidelinesAdminister benefits and oversee medical treatment and billing managementCoordinate with attorneys, medical providers, vendors, nurse case managers, and vocational specialistsManage proactive diary systems, claim documentation, and workflow organizationSet and manage reserves within established authority levelsHandle settlements, claim closures, and resolution strategiesIdentify opportunities for subrogation, apportionment, and excess reportingAssist with audits, reporting requirements, and compliance initiativesMentor and support less experienced Claims ExaminersSupport floating or temporary caseloads based on operational needsQualifications:5+ years of Workers? Compensation claims experienceStrong experience handling complex and litigated claims filesKnowledge of workers? compensation regulations and medical terminologyAbility to independently manage claims and prioritize competing deadlinesStrong analytical, organizational, and communication skillsExperience working with attorneys, vendors, and medical providersProficiency with Microsoft Word and Excel preferredCalifornia Self-Insurance Certificate or applicable jurisdictional certification preferredWhy This OpportunityHybrid flexibility with work-from-home opportunitiesHigh-impact role supporting complex claims operationsCollaborative team environment with leadership supportOpportunity to mentor junior claims professionalsStable organization with strong long-term growth potentialCompensation & Benefits$80K $83K compensation packageMedical, dental, and vision insuranceLife and disability insurance401(k) plan with match11 Paid holidays + 2 Floating Holidays?PTO (16 days + additional PTO for volunteering and more)Dependent Scholarship ProgramPresident's Award ($1500)HSAFitness Club Membership AllowanceHybrid remote flexibilityIf you?re an experienced Workers? Compensation professional looking for a dynamic claims environment with flexibility and career stability, we?d love to connect.