Claims Specialist, Workers Compensation

Responsibilities

• Review, analyze, and process moderately to complex claims using advanced technology.
• Make decisions on liability, evaluate losses, negotiate settlements, and manage claims involving bodily injury or property loss.
• Conduct investigations by interviewing involved parties, collecting documentation, and securing evidence.
• Assess policy coverage, determine reserve requirements, and adjust reserves as needed.
• Cookordination litigation activities, attend trials, and ensure timely, cost-effective resolutions.
• Assist in assigning claims, providing technical guidance, mentoring team members, and participating in quality reviews.
• Engage third-party experts such as adjusters and medical examiners; refer claims to specialized units when appropriate.

Qualifications & Skills

• Minimum of 2 years of experience in Workers' Compensation claims handling, including investigation through resolution.
• Bachelor’s degree or equivalent work experience; claims adjustment, insurance, or formal training preferred.
• Knowledge of claims investigation, medical terminology, and legal aspects of claims.
• Required to obtain and maintain relevant licenses; continuing education for certifications is a plus.