Workers Compensation, Claims Specialist
Based in the United StatesFull-TimeMiddle
Salary69,500 - 129,000 USD per year
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Job Details
- Experience
- 3–5 years
- Required Skills
- Negotiation
Requirements
- 3–5 years of experience in workers’ compensation or similar insurance claims.
- Strong knowledge of insurance principles and claims handling.
- Deep understanding of workers’ compensation laws across multiple jurisdictions.
- Familiarity with medical terminology and legal procedures.
- Proficiency with claims documentation and management systems.
- Excellent analytical and decision-making capabilities.
- Strong negotiation and interpersonal communication skills.
- Ability to manage complex workloads independently.
- Bachelor’s degree in business administration or related field preferred.
- Relevant professional certifications preferred.
Responsibilities
- Manage end-to-end workers’ compensation claims from intake through resolution.
- Determine compensability, benefit eligibility, and benefit rates.
- Conduct thorough investigations and coordinate medical reviews.
- Utilize nurse case management and support return-to-work initiatives.
- Monitor and adjust case reserves and manage litigation.
- Ensure timely and accurate regulatory reporting.
- Identify fraud and subrogation opportunities.
- Maintain high-quality documentation in claims systems.
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