Claims Supervisor - Workers Compensation

Workers’ Compensation Claims Adjuster (Level II or III) – Hawaii

Location: Kapolei, HI (Hybrid for local candidates | Remote for candidates outside the island but must be in Hawaii)

Position Summary

A leading Third Party Administrator is seeking an experienced Workers’ Compensation Claims Adjuster to manage a diverse caseload of Hawaii workers’ compensation claims. Reporting to Claims Leadership, this role is responsible for end-to-end claim ownership—from intake and investigation through resolution—while operating within established authority levels and client guidelines.

This position involves regular collaboration with injured workers, employers, medical providers, attorneys, vendors, and internal partners. Claim complexity, litigation exposure, settlement authority, and leadership expectations will align with the Adjuster’s level (Examiner II or Examiner III).

Core Responsibilities (Examiner II & III)

• Oversee a full inventory of workers’ compensation claims, including medical-only, indemnity, future medical, and litigated files

• Conduct prompt and comprehensive claim investigations; document findings thoroughly and accurately

• Evaluate compensability and administer benefits in compliance with Hawaii statutes and applicable claim-handling instructions

• Coordinate medical care, authorize treatment, and manage medical billing activity

• Serve as the primary point of contact for claimants, employers, providers, vendors, and clients

• Establish, review, and adjust claim reserves in accordance with company and client standards

• Maintain detailed claim notes, action plans, and diary entries reflecting claim strategy and progress

• Negotiate, resolve, and close claims within assigned settlement authority

• Perform regular file reviews and respond to client inquiries in a timely manner

• Identify emerging trends, risk indicators, and safety concerns; communicate insights proactively

• Utilize claims systems and internal technology to manage workload efficiently

• Comply with all internal policies, procedures, and best practices

• Complete additional duties as assigned

Advanced / Senior-Level Responsibilities (Primarily Examiner III)

• Independently manage highly complex, catastrophic, and litigated workers’ compensation claims

• Retain and collaborate with defense counsel; actively participate in hearings, mediations, and settlement negotiations

• Evaluate and pursue:

  • Subrogation opportunities

  • Apportionment considerations

  • Excess coverage reporting and reimbursement

• Support regulatory compliance through audit preparation and state-required reporting

• Develop proactive claim strategies focused on timely, cost-effective resolution

• Participate in client file reviews and meetings as requested

• Provide mentoring and technical support to junior Claims Examiners

• Handle multi-jurisdictional claims when assigned

Qualifications

Education & Experience

Claims Examiner II

• Bachelor’s degree in a related discipline preferred

• 3 years of workers’ compensation claims experience, or an equivalent combination of education and experience

Claims Examiner III

• 5 years of progressive workers’ compensation claims experience

• Proven experience managing complex and litigated indemnity claims

Knowledge, Skills & Abilities

• Strong working knowledge of workers’ compensation laws, regulations, and medical terminology

• Ability to independently assess risk, analyze complex issues, and manage claims strategically

• Clear, professional written and verbal communication skills

• Strong organizational, analytical, and time-management capabilities

• Ability to communicate effectively with diverse stakeholders at all organizational levels

• Proficiency with Microsoft Word and Excel preferred

Licensure

• Active Hawaii Workers’ Compensation Adjuster License required