Regional Claims Specialist Senior

About the role

The organization operates in the workers' compensation insurance sector, providing claims management services with a focus on efficient, empathetic handling and customer advocacy throughout the life of a claim. The Regional Claims Specialist Senior manages workers' compensation claims primarily in Connecticut, with potential coverage in Maryland, Delaware, and Pennsylvania. This role delivers on‑site and virtual customer service, advocates for injured workers, and ensures quality claims management while building relationships, resolving claims effectively, and supporting policyholders and agents through clear communication and expertise.

Responsibilities

• Manage claims following best practices and company guidelines with accurate documentation
• Provide customer service focused on injured worker advocacy to improve outcomes
• Determine compensability and coverage through gathering medical and factual evidence
• Administer timely and accurate benefits delivery
• Identify potential fraud and escalate as appropriate
• Investigate subrogation opportunities and coordinate recovery efforts
• Communicate proactively with injured workers, medical providers, attorneys, policyholders, and agents
• Evaluate risks and develop strategic plans to mitigate exposures
• Assign and refer claim petitions to counsel and work to resolve claims within authority
• Build rapport with policyholders and agents, conduct on‑site investigations as needed
• Educate policyholders and agents on procedures, policies, and claims practices
• Prepare for and attend claim reviews at policyholder or agent locations or virtually
• Serve as liaison between policyholders/agents and internal departments
• Represent claims in on‑site meetings for onboarding new policyholders
• Participate in relevant training programs
• Recommend process improvements to enhance efficiency and service
• Adhere to the organization’s Code of Business Conduct, compliance policies, and applicable laws

Requirements

• Minimum 5 years experience as a Workers' Compensation Claim Representative or equivalent
• Advanced knowledge of medical terminology and Connecticut workers' compensation regulations
• Experience with liens and Medicare Set‑Asides for settlements
• Strong written and oral communication skills
• Ability to work independently and in a team
• Organizational skills and sound decision‑making
• Proficiency in automated claim systems and Microsoft Office (Word, Outlook)
• Licensed in Connecticut to adjust workers' compensation claims
• Ability to travel approximately 2 to 3 days per week for business meetings

Preferred qualifications

• Associate or bachelor's degree
• Relevant insurance designations (AIC, CPCU)
• Experience with Guidewire Claim Center, OnBase, Microsoft Teams, Excel, PowerPoint
• Knowledge of claims handling in Pennsylvania, Maryland, and Delaware
• Licensure in other states, including Delaware

Pay

Salary range: $81,124 to $94,141. Compensation is commensurate with experience and credentials. Eligible full‑time employees receive a Total Rewards package, including discretionary bonuses.

Benefits

• 401(k) with employer match up to 8% plus service contributions
• Health, dental, and vision insurance
• Life and disability coverage
• Generous paid time off, paid sick leave, and paid parental leave (including state‑mandated leave)
• Eligibility for discretionary bonuses

Our client is an equal opportunity employer committed to diversity and inclusion. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.