This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Workers Comp Claims Specialist based in the United States.
The Workers Comp Claims Specialist manages complex workers’ compensation claims with a focus on timely, effective, and cost-conscious resolution.
You’ll oversee a portfolio of legacy and multi-jurisdictional claims while developing strategies based on injury characteristics, jurisdiction, and claimant circumstances.
The role combines claims expertise, risk analysis, stakeholder management, documentation, and sound decision-making.
You’ll work closely with third-party administrators, adjusters, nurse case managers, attorneys, and internal teams to monitor reserves and drive claims toward closure.
Your work will directly support risk-management objectives by helping control financial exposure and improve claims outcomes.
The environment is fast-paced and collaborative, with an emphasis on customer service, adaptability, accountability, and continuous improvement.
This is a fully remote U.S. position offering comprehensive benefits and opportunities for professional growth.
Manage a portfolio of legacy and multi-jurisdictional workers’ compensation claims, maintaining a focus on timely, effective, and cost-conscious resolution.
Develop proactive claim strategies based on injury type, jurisdiction, affected body part, claimant profile, and applicable workers’ compensation practices.
Establish and maintain accurate and timely claim reserves to support reliable financial and actuarial analysis.
Drive claim closures and resolution strategies to reduce financial exposure and improve overall claim outcomes.
Maintain comprehensive and timely documentation in the internal Risk Management Information System (RMIS), including medical, legal, and claim developments.
Participate in regular claim reviews with third-party administrators (TPAs), adjusters, nurse case managers, and attorneys to align on reserves, action plans, and resolution strategies.
Build effective relationships with internal and external stakeholders through proactive, professional, and responsive communication.
Support team members with wage verification and wage statement requests.
Prepare and distribute required notifications to branch managers related to resignation or release check requests.
Assist with claims reported with unknown locations to support accurate reporting and processing.
Manage electronic mail distribution for the Risk Services department, ensuring information and requests are routed promptly and accurately.
Identify opportunities to simplify processes, improve the customer experience, and enhance claims-management practices.
Handle difficult or sensitive situations with professionalism, diplomacy, and composure.
Perform other related duties as needed to support Risk Management objectives.
High school diploma or GED required; an Associate’s or Bachelor’s degree is preferred.
Experience in workers’ compensation, risk management, insurance, claims, or a related field is strongly preferred.
Previous experience in the staffing industry is preferred.
Bilingual English/Spanish skills are preferred.
Strong knowledge of claims processes and the ability to manage complex or multi-jurisdictional matters is valuable.
Strong analytical and problem-solving skills, with the ability to evaluate multiple options and determine appropriate courses of action.
Sound judgment and decision-making skills, particularly when balancing financial exposure, risk, competing priorities, and claim resolution objectives.
Excellent written and verbal communication skills, with the ability to adapt communication to different internal and external audiences.
Strong customer-service orientation and the ability to establish productive, sustainable professional relationships.
Proficiency with Microsoft Word, Excel, and Outlook, along with the ability and willingness to learn new systems and technology platforms.
Strong organizational and time-management skills, with the ability to manage multiple claims, deadlines, and priorities effectively.
Adaptability and a willingness to learn new concepts in a fast-paced and continuously changing environment.
High level of integrity, professionalism, discretion, and ethical judgment.
Ability to remain composed and diplomatic when handling challenging or sensitive situations.
Results-oriented approach with a strong commitment to accountability and timely execution.
Annual base salary range of $50,000–$55,000, with actual compensation determined by qualifications, relevant experience, skills, education, certifications, licenses, and work location.
Fully remote/work-from-home opportunity within the United States.
Medical, dental, and vision benefits beginning on the first day of the month following hire.
Prescription drug benefits.
401(k) retirement plan.
Paid Time Off.
8 paid holidays per year.
2 floating holidays per year.
Parental leave.
Wellness program.
Incentive programs.
Collaborative team environment.
Opportunities for career development and advancement.
Career paths that support internal mobility and promotion.
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