Senior Claims Representative (Remote)

About Our Client

The organization operates within the insurance industry, specializing in workers' compensation claims. It addresses the challenges of managing complex, high-exposure claims involving legal and medical intricacies. The company focuses on delivering thorough claims handling, fraud investigations, and strategic risk management to support injured workers and policyholders.

About the Opportunity

The Senior Claims Representative is responsible for managing complex workers' compensation claims with significant financial exposure. This role involves leading investigations, overseeing medical case management, developing return-to-work strategies, and collaborating across departments to improve claims processes. The position contributes to the organization's effectiveness by ensuring regulatory compliance, guiding high-stakes negotiations, and mentoring junior staff.

Responsibilities

• Manage complex claims with significant financial and legal factors.
• Conduct in-depth investigations into coverage, compensability, and fraud.
• Oversee medical case management for catastrophic injuries.
• Review and negotiate large or complex medical bills.
• Develop and implement return-to-work strategies.
• Ensure accurate benefit calculations and compliance.
• Lead subrogation efforts and negotiate recoveries.
• Partner with legal teams on settlements and litigation.
• Oversee Medicare compliance and structured settlement negotiations.
• Prepare strategic reports for management decision-making.
• Maintain data integrity and prepare claims for corporate review.
• Lead cross-departmental initiatives for claims and risk management.
• Resolve escalated customer service issues.
• Mentor and coach junior and intermediate adjusters.
• Support workforce development and succession planning.

Requirements

• Bachelor’s degree in business or related field preferred, or equivalent experience.
• 7–10 years of workers’ compensation claims experience.
• Preferred: Associate in Claims (AIC), AIM, or CPCU designation or ability to obtain.
• Preferred: Texas All-Lines license.
• Valid driver’s license.

Benefits & Perks

• Medical, dental, and vision plans including fertility benefits and adult orthodontia.
• Employer-paid life insurance and short and long-term disability.
• Wellness and recognition programs with employer-paid incentives.
• Flexible Spending Account and Dependent Care options.
• Health Savings Account with generous employer contribution.
• Paid time off including PTO, holidays, volunteer time, parental leave, and other leaves.
• Employee assistance programs.
• 401(k) retirement plan with employer match and profit sharing.
• Adoption and tuition assistance.