Role Description Our client, an A-rated Insurance Carrier, is seeking to add an experienced Senior Workers' Compensation Claims Examiner to their growing team. This is a fully remote opportunity responsible for handling moderate to complex Iowa Workers' Compensation Lost Time claims from inception through resolution. Qualified candidates must possess strong knowledge of Iowa Workers' Compensation laws, with experience handling claims in other Midwestern jurisdictions considered a plus. - Manage moderate to complex Iowa Workers' Compensation Lost Time claims from inception through closure. - Evaluate coverage, investigate claims, and develop appropriate claim resolution strategies. - Negotiate settlements with injured workers, attorneys, and other involved parties. - Coordinate with defense counsel and outside experts while directing the litigation process on litigated files. - Attend mediations, settlement conferences, and other proceedings involving serious injury claims. Qualifications - 5–10+ years of Workers' Compensation claims handling experience. - Strong knowledge of Iowa Workers' Compensation laws and regulations. - Prior experience managing litigated Workers' Compensation claims. - Excellent customer service, communication, and organizational skills. - High School Diploma required; Bachelor's Degree preferred. Benefits - $85,000–$110,000 annual base salary, plus a 10% target bonus. - Flexible schedule with a fully remote work environment. - Competitive Medical, Dental, Vision, and Life Insurance benefits. - Paid Parental Leave. - Employer-matching 401(k) plan. Company Description

• Responsible for managing complex workers compensation claims • Ensure timely adjudication of claims within company standards and regulatory requirements • Contact with employers, injured workers, and medical providers within designated timelines • Documentation of claims and wage information • Timely completion of claims determinations and payments • Manage legal aspects of claims and assign attorneys • Supervise claims assistants and coordinate assignments • Monitor claims for reporting requirements

Role Description Point C is looking for a detail-oriented and motivated Claims Examiner to join our team. In this role, you’ll be responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations. The ideal candidate is analytical, organized, and experienced in self-funded or third-party administration environments. - Adjudicate new claims and process adjustments, including denials upon receipt of additional information - Review and resolve appeals and subrogation/third-party liability cases - Manage individual inventory to ensure timely turnaround and production goals are met - Ensure claims are processed in accordance with stop loss contract terms - Respond to internal and external inquiries via email and other channels within established timeframes - Follow up on missing or incomplete information to ensure claims can be accurately processed - Maintain minimum production, financial, and procedural accuracy standards on a monthly basis Qualifications - Experience with Third Party Administrator (TPA) or self-funded claims administration preferred - At least 2+ years of experience in insurance claims processing required - Experience reviewing and finalizing claim payments for accuracy in accordance with plan policies - Ability to interpret and apply plan documents to ensure accurate claims adjudication - Demonstrated understanding of both claim review processes and underlying benefit plan design - Experience with HealthPac, El Dorado, Javelina, or VBA systems preferred - Working knowledge of CPT and ICD-10 coding - Basic understanding of medical terminology - Strong communication and customer service skills - Proficiency in Microsoft Office and general computer applications - Ability to maintain confidentiality and comply with all company policies and procedures - Able to work independently with minimal supervision - Ability to prioritize, multitask, and work overtime as needed - Associate Degree Preferred Requirements Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role. Pay Transparency: $19 — $22 USD Benefits - Comprehensive medical, dental, vision, and life insurance coverage - 401(k) retirement plan with employer match - Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) - Paid time off (PTO) and disability leave - Employee Assistance Program (EAP) Company Description At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.

• Efficient claim management and documentation of declaratory judgment new loss assignments • Clear understanding of coverage issues and complex coverage decisions • Develop and enforce litigation management strategy on each claim • Review and analyze file materials, policies, motions, and pleadings • Collaborate with other claim adjusters to evaluate litigated claims • Stay informed on industry trends and utilize AI tools