Senior Claims Representative

About the role

Pinnacol Assurance is a seasoned workers' compensation insurance provider based in Colorado. With over 100 years of experience, Pinnacol is dedicated to providing exceptional service and support to its clients.

Responsibilities

• Strategically and proactively manage claims and claim-related issues to the most expedient, cost-effective resolution.
• Provide quality customer service to all stakeholders, including proactive communication and follow-through.
• Identify claims requiring complex management and work with team members to resolve concerns, escalate to appropriate levels, or secure appropriate resources.
• Demonstrate consistent follow-through with all stakeholders to ensure efficient and effective resolution of each issue and claim.
• Contact stakeholders as required by Company best practices to promptly investigate accident and injury circumstances, determine compensability, and address red flag issues.
• Proactively manage open claims, including expedient and cost-effective medical case management, disability management, and litigation management.
• Coordinate and oversee necessary resources for optimal claim management, action plan development, and resolution, including other team members, Leads, Owners, Underwriters, Business Directors, Legal resources, Return-to-Work Consultants, Safety Consultants, Medical Case Managers, Utilization Review Specialists, MedPay Liaisons, Provider Relations Specialists, and Claims Directors.
• Communicate with stakeholders as needed to manage and resolve open claims, including phone, email, fax, and face-to-face meetings, and accurately document correspondence.
• Facilitate early return to work for injured workers by working with policyholders and Return-to-Work Consultants if needed.
• Manage benefit authorization and payment on compensable claims, filing all necessary paperwork with the Colorado DOWC as required.
• Evaluate claims for settlement, determining the most likely medical path and return to work possibilities, and negotiating settlements with legal counsel or directly with injured workers or their counsel.
• Provide authority for level 1 and 2 Claims Representatives to settle claims within their senior authority, reviewing evaluations, coaching, and documenting authority.
• Inform policyholders and agents of claim status and significant developments as required by Company best practices.
• Analyze medical information to determine authorization/payment appropriateness or referral to other Company resources.
• Process medical records as required by Company documented best practices.
• Prepare for and attend settlement conferences and hearings.
• Evaluate medical bill referrals to determine relatedness and appropriateness, authorizing payment or denying bills with appropriate documentation.
• Communicate decisions to billers and parties to the claim.
• Read and analyze medical records to maintain an accurate understanding of a claim's medical progress, recognizing when a treatment plan is outside of authorized care and communicating with internal and external resources.
• Provide authority for level 2 Claims Representatives to reserve claims within senior authority, reviewing proposed reserves, providing coaching, and documenting authority.
• Review and prepare for settlement conferences and hearings.
• Evaluate medical bill referrals to determine relatedness and appropriateness, authorizing payment or denying bills with appropriate documentation.
• Communicate decisions to billers and parties to the claim.
• Read and analyze medical records to maintain an accurate understanding of a claim's medical progress, recognizing when a treatment plan is outside of authorized care and communicating with internal and external resources.
• Provide authority for level 2 Claims Representatives to reserve claims within senior authority, reviewing proposed reserves, providing coaching, and documenting authority.

Qualifications

• 3 or more years of previous experience managing indemnity workers' compensation claims.
• Ability to apply Colorado jurisdictional requirements.
• Experience with litigation management and claim resolution/settlement.
• Strong written and verbal communication skills.
• Customer focus and ability to provide a caring customer experience.
• Curiosity and a strong desire to learn and seek out information.
• Organization skills and ability to manage multiple priorities and a large workload.
• Strategic thinking and ability to solve complex problems.
• Negotiation skills and ability to negotiate with stakeholders.
• Relationship building and ability to develop relationships with stakeholders.

Additional Duties

• Serve as a resource and mentor to level 1 and 2 Claims Representatives.
• Participate in projects and committees as requested.
• Maintain all Senior Claims Representative performance standards.

Work Environment / Physical Activities

Regular attendance required. Extensive telephone and computer work in an office environment. Attend marketing visits with agents and/or policyholders as required.

Disclaimer

This description is not an exhaustive list of all duties, responsibilities, or qualifications associated with this job. We can't do our work without people like you. Our employees are extraordinary and committed to making a difference. Here's some of the ways we show our appreciation. Our benefits go beyond the basics. You'll get to choose from diverse benefit offerings for medical, dental, and vision. We care about each other. We enjoy a positive, collaborative work environment. We are hard workers and high performers. We love who you are. Pinnacol is on a journey to embody diversity, equity, and inclusion. We're committed to creating a culture that deeply values differences, where everyone feels like they belong. Take a day (or 20!) off. Enjoy 20 paid days off your first full year plus 9 paid holidays. Get your learning on. We promote a learning culture to help you master your current job and cultivate the skills of the future through a variety of on-site, online, and off-site professional development opportunities. Give back and get paid. Through our employee volunteer program, Pinnacol in Action, employees receive paid time off to volunteer with Colorado nonprofits. Share in our success. You'll have the opportunity to earn a quarterly incentive, up to 12 percent of your annual base salary, when your team exceeds their goals and objectives. When we find the right person, we try to put our best foot forward with an offer that excites you. We consider what you'd like to be paid, the skills and experience you bring, what similar jobs pay in the Denver area, and make sure there's equal pay for equal work among those you'll be working with. The compensation amount for this role is targeted at $80,900—$85,600 USD. Final offer amounts are determined by multiple factors including your experience and expertise and may vary from the amounts listed above. Want to love your work? Apply today! Pinnacol is committed to working with and providing reasonable accommodations to applicants with disabilities. To request assistance with the application process, please email recruiting_team@pinnacol.com. This posting will close 15 days after being published: July 15 2026. Salary Range $80,900—$85,600 USD.