WorkersCompensation,ClaimsSpecialist

## Accountabilities Manage end-to-end workers’ compensation claims, including investigation, evaluation, reserving, negotiation, and resolution, while ensuring compliance with state-specific regulations and company guidelines. Determine compensability, benefits eligibility, average weekly wage, and benefit rates while securing required documentation and filing mandatory notices and reports. Conduct thorough investigations, coordinate medical reviews, utilize nurse case management, and support return-to-work initiatives to optimize claim outcomes. Monitor and adjust case reserves, manage litigation when necessary, and collaborate with legal counsel, medical experts, and recovery/subrogation teams. Ensure timely and accurate reporting, including Medicare obligations, reinsurance reports, and other regulatory or internal requirements. Identify fraud and subrogation opportunities while maintaining high-quality documentation in claims systems. Deliver consistent, professional communication and customer service to all stakeholders throughout the claim lifecycle. Requirements: 3–5 years of experience handling workers’ compensation claims or similar insurance claims environment. Strong knowledge of insurance principles, claims handling practices, and workers’ compensation laws across multiple jurisdictions. Familiarity with medical terminology, legal procedures, and claims systems used for documentation and case management. Excellent analytical and decision-making skills, with the ability to interpret coverage, liability, and jurisdictional requirements. Strong negotiation, communication, and interpersonal skills for interacting with injured workers, attorneys, medical providers, and internal teams. Ability to manage complex workloads independently while maintaining accuracy and meeting deadlines. Bachelor’s degree in business administration or related field preferred, along with relevant certifications where applicable. Benefits: Competitive salary range: $69,500 – $129,00