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Complex Claims Examiner Jobs (NOW HIRING)

Safepoint MGA, LLC

Sr. Claims Examiner

Tampa, FL · On-site

Job Summary The Senior Claims Examiner is a remote position responsible for handling daily ... Handle daily residential and commercial property claims, CAT claims, and complex claims across ...

Safepoint MGA, LLC

Sr. Claims Examiner

Tampa, FL · On-site

Job Summary The Senior Claims Examiner is a remote position responsible for handling daily ... Handle daily residential and commercial property claims, CAT claims, and complex claims across ...

Hiscox

Sr. Claims Examiner

Chicago, IL · On-site

$80K - $110K/yr

The Senior Claims Examiner adjudicates assigned claims within given authority and provides ... Adjusts and resolves moderate to complex claims that includes all phases of litigation * Accurately ...

Hiscox

Sr. Claims Examiner

Boston, MA · On-site

$80K - $110K/yr

The Senior Claims Examiner adjudicates assigned claims within given authority and provides ... Adjusts and resolves moderate to complex claims that includes all phases of litigation * Accurately ...

Allcat Claims Service

Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties ... Reviews incoming moderate to complex residential and commercial property estimates for accuracy and ...

New

Allcat Claims Service

Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties ... Reviews incoming moderate to complex residential and commercial property estimates for accuracy and ...

New

Hiscox

Sr. Claims Examiner

Scottsdale, AZ · On-site

$80K - $110K/yr

The Senior Claims Examiner adjudicates assigned claims within given authority and provides ... Adjusts and resolves moderate to complex claims that includes all phases of litigation * Accurately ...

Allcat Claims Service

Claims Examiner

New York, NY · Remote

Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties ... Reviews incoming moderate to complex residential and commercial property estimates for accuracy and ...

New

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Complex Claims Examiner information

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$15

$29

$45

How much do complex claims examiner jobs pay per hour?

As of Jul 14, 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 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 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 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.

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.
More about Complex Claims Examiner jobs
What job categories do people searching Complex Claims Examiner jobs look for? The top searched job categories for Complex Claims Examiner jobs are:
Complex Claims Examiner jobs near you
Infographic showing various Complex Claims Examiner job openings in the United States as of July 2026, with employment types broken down into 91% Full Time, 7% Part Time, and 2% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.
Claims Examiner

Claims Examiner

Imagine Staffing Technology

Bartlesville, OK • Remote

$32/hr

Full-time

Re-posted 26 days ago

Job description

Job Profile
Job Title: Claims Examiner
Location: Remote,
Hire Type: Contingent
Pay Range: $32/hr.
Work Model: Remote
Work Shift: Monday-Friday 8 am – 4:30 pm
Recruiter Contact: Sean Craft I sean@marykraft.com I 443-345-3305
Nature & Scope:
Positional Overview
We are seeking an experienced Claims Examiner – Workers’ Compensation to manage complex and high-exposure workers’ compensation claims. This role is responsible for analyzing technically difficult claims, determining benefits due, managing litigated cases, and ensuring proper adjudication in alignment with service expectations, industry best practices, and client-specific requirements.
The Claims Examiner will also identify subrogation opportunities, negotiate settlements within designated authority, and ensure cost-effective claim resolution while maintaining compliance with statutory guidelines.
Role & Responsibility:
Tasks That Will Lead to Your Success
  • Analyze and process complex or technically challenging workers’ compensation claims by conducting thorough investigations to determine claim exposure.
  • Develop and execute strategic action plans to drive timely and appropriate claim resolution.
  • Negotiate settlements within designated authority levels.
  • Establish and maintain accurate and timely claim reserves; ensure reserve adequacy throughout the life of the claim.
  • Calculate and approve benefit payments, adjustments, and settlements within authority guidelines.
  • Prepare and submit required state filings within statutory deadlines.
  • Manage the litigation process and coordinate with defense counsel to ensure cost-effective outcomes.
  • Coordinate vendor referrals for additional investigation, medical management, or litigation support.
  • Apply cost containment strategies, including use of strategic vendor partnerships.
  • Manage claim recoveries including subrogation, Second Injury Fund recoveries, and Social Security and Medicare offsets.
  • Report claims to excess carriers and respond promptly to requests for direction.
  • Communicate claim activity and updates with claimants and clients, maintaining strong professional relationships.
  • Ensure claim files are properly documented and coded accurately.
  • Escalate cases to supervisors or management as appropriate.
Skills & Experience
Qualifications That Will Help You Thrive
  • High School Diploma or GED required.
  • Bachelor’s degree preferred.
  • Professional certifications relevant to workers’ compensation claims handling preferred.
  • Minimum five (5) years of workers’ compensation claims management experience or equivalent combination of education and experience required.
  • Experience handling high-exposure and litigated claims strongly preferred.
  • Subject matter expertise in workers’ compensation insurance principles and applicable laws.
  • Knowledge of recoveries, offsets, deductions, disability duration, and cost containment practices.
  • Familiarity with medical management and Social Security/Medicare procedures related to workers’ compensation.
  • Strong analytical and interpretive skills.
  • Excellent verbal and written communication skills, including presentation ability.
  • Proficiency in Microsoft Office and claims management systems.
  • Strong organizational, interpersonal, and negotiation skills.
  • Ability to work effectively in a team environment.
  • Demonstrated ability to meet or exceed service expectations.