Senior Workers' Compensation Claims Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Workers' Compensation Claims Specialist based in United States.

This role is responsible for managing complex and high-profile Workers’ Compensation claims from initial intake through resolution.

You will investigate claims, assess compensability, establish reserves, and develop strategies focused on achieving effective outcomes.

The position requires close collaboration with case managers, attorneys, customers, claimants, and other stakeholders throughout the claims lifecycle.

You will also oversee subrogation, litigation, recoveries, and return-to-work initiatives while maintaining compliance with applicable regulations.

Strong judgment and analytical skills will be essential when evaluating risks, controlling claim costs, and negotiating settlements.

The role combines independent decision-making with team collaboration and opportunities to support the development of claims expertise across the organization.

This is a strong opportunity for an experienced claims professional seeking a senior-level role with meaningful responsibility for complex Workers’ Compensation matters.

Accountabilities

• Receive and manage Workers’ Compensation claims, confirming coverage, acknowledging claims, and ensuring appropriate documentation is maintained.
• Investigate claims thoroughly to determine validity, compensability, liability, and appropriate next steps, including submitting required documentation to applicable state agencies.
• Establish appropriate claim reserves and authorize payments within designated authority levels.
• Develop and maintain detailed action plans in partnership with case managers and outcomes managers to reduce claim costs and achieve favorable resolutions.
• Coordinate early return-to-work initiatives with employers, employees, medical professionals, case managers, and other relevant parties.
• Manage subrogation, litigation, and settlement activities as applicable to individual claims.
• Identify and pursue potential recoveries across various claim-related opportunities.
• Report qualifying claims to excess carriers and coordinate related requirements.
• Maintain clear and timely communication with customers and claimants regarding claim status, progress, and resolution.
• Ensure claim handling practices comply with client requirements, carrier guidelines, and applicable state laws and regulations.
• Participate in claims reviews and provide relevant information, analysis, and recommendations as needed.
• Develop and maintain professional relationships with customers and other key stakeholders.
• Support team members by sharing knowledge and strengthening understanding of Workers’ Compensation claims practices.
• Perform additional responsibilities as assigned while maintaining high standards of service, accuracy, compliance, and professionalism.

Requirements

• Bachelor’s degree or an equivalent combination of education and relevant professional experience.
• At least 3 years of industry experience with demonstrated Workers’ Compensation claims handling expertise.
• Current state certification or licensing as an experienced claims adjuster.
• Current Workers’ Compensation license or certification must be maintained throughout employment.
• Michigan adjuster licensing and demonstrated proficiency with Michigan Workers’ Compensation are preferred.
• Self-Insured Certificate experience or credentials are preferred.
• Strong understanding of the Workers’ Compensation claims administration process, case management practices, and cost containment strategies.
• Excellent written and verbal communication skills, with the ability to communicate effectively with customers, claimants, attorneys, case managers, and internal teams.
• Strong analytical, problem-solving, and decision-making capabilities, with the ability to evaluate complex claims and determine appropriate courses of action.
• Strong interpersonal, organizational, and time-management skills with the ability to manage multiple claims and priorities effectively.
• Proficiency with Microsoft Office applications, including Excel, and the ability to quickly adapt to claims-related technology and systems.
• Ability to work independently while also contributing effectively within a collaborative team environment.
• Ability to coach and support colleagues by sharing claims knowledge and best practices.
• Strong attention to detail and commitment to compliance, documentation accuracy, customer service, and ethical claims handling.

Benefits

• Annual pay range of $61,053 to $98,334, with compensation varying based on factors such as location, skills, experience, qualifications, internal equity, and market conditions.
• Full-time employment with a remote work arrangement.
• Comprehensive medical coverage, including a high-deductible health plan with pharmacy benefits.
• Dental and vision insurance.
• Long-term disability and life insurance coverage.
• Health Savings Account and Flexible Spending Account options.
• Accident and critical illness insurance.
• Pre-paid legal insurance.
• Parking and transit Flexible Spending Account options.
• 401(k) and Roth 401(k) retirement plans.
• Paid time off.
• Opportunity to work on complex Workers’ Compensation claims with significant responsibility and visibility.
• Collaborative environment offering opportunities to develop claims expertise and support team members.
• Opportunity to contribute to effective claims outcomes, cost containment, and quality customer service.