Claims Specialist IV
About the role
We’re looking for a seasoned Claim Specialist IV to take ownership of complex lost time claims while serving as a mentor and subject matter expert within our Claims team. This is a high-visibility role designed for a skilled professional who thrives in a fast-paced environment, exercises sound judgment, and enjoys elevating the capabilities of others.
What You’ll Do
Own the full claim lifecycle: Investigate, evaluate, negotiate, and resolve lost time workers’ compensation claims within designated settlement and reserving authority
Analyze complex exposures: Assess compensability, medical, legal, and indemnity factors while proactively managing risk and claim cost drivers
Navigate jurisdictional requirements: Ensure compliance with state-specific WC laws, litigation processes, and regulatory guidelines
Strategically manage claims: Develop and execute resolution strategies, including collaboration with defense counsel, medical providers, and vendors
Exercise advanced judgment: Handle a high-exposure, complex caseload with a high degree of autonomy and limited supervision
Develop others: Design and deliver training sessions, research materials, and technical guidance for less experienced adjusters
Serve as a subject matter expert: Provide leadership in best practices, reserving, settlement strategy, and claim handling excellence
What Sets This Role Apart
Complex, high-impact caseload: Manage litigated and non-litigated lost time claims requiring deep technical expertise
Expanded authority: Settlement and reserving authority aligned with your experience and demonstrated capabilities
Influential role: Shape claim outcomes and elevate team performance through mentorship and knowledge sharing
Cross-functional exposure: Regular collaboration with legal, medical management, underwriting, and risk partners
What You Bring
Proven experience managing lost time claims with increasing complexity - 4 years of WC lost time claim handling required
Strong negotiation and analytical skills with a focus on resolution
Ability to work independently while maintaining high-quality outcomes
Passion for mentoring, training, and knowledge sharing
Demonstrated ability to handle confidential, high-impact situations with professionalism