Claim Examiner Workers' Compensation (WC)

Insurance Company REMOTE Needed to start in June 2026 Contract to hire Must work on W2 No C2C Loss Time Adjuster with Workers Compensation for Virginia and Atlantic States Position OverviewCompany is seeking an experienced Loss Time Adjuster to support the Workers'' Compensation team handling claims within the Atlantic region, with a strong focus on Virginia jurisdictional experience. This is a remote opportunity supporting an existing team vacancy and offers the potential to transition into a

CA Counsel License is Must Title: Counsel (Workers Compensation Attorney) Location: REMOTE (Required: Must reside in CA and hold CA license) Pay Rate: $61.09/Hr. Duration: 6 months with possible extension (however the HM will need to reassess every 60-90 days) Contract to Hire: Possible for the right fit Most important skillset: CA License, strong technical skills, strong knowledge of WC. Workers Compensation Attorney As a Staff Counsel you will represent the company and its policyholders in wor

Should have strong MMIS health care domain experience and should have good knowledge of Medicaid and Medicare.Should have hands-on experience on claims processing and Adjudication processes.Must have good experience in Reference code/data sets required in Claims adjudication.Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.In depth understanding of Claims and Claims lifecycleClaim System:Testing knowledge and E2E Testing:

Minimum of 8+ years of experience in health care experience especially in MMIS domain.In depth understanding of Claims and Claims lifecycle:Claim submission Paper and EDI X12Adjudication Payment Cycle (Finance)ReportingEncounters and CapitationEDI X12 formats like837P/I/DX12 formats 835,834,270/271,276/277Familiarity with systems like CMdS, GHS, Facets and etcAbility to validate Test scenarios and test plans, test data.SQL: To validate data in backend tables (e.g., claim status, payment details