Senior Claims Representative - Workers'' Compensation (Remote)

1. About Our Client:The organization operates within the insurance industry, specializing in workers'' compensation claims. It addresses the challenge of managing complex, high-exposure claims that involve legal and medical intricacies. The organization focuses on providing comprehensive claims handling, fraud investigation, and strategic risk management to support injured workers and policyholders. 2. About the Opportunity:The Senior Claims Representative plays a critical role in managing complex workers'' compensation claims with significant financial and legal exposure. This position leads investigations, collaborates across departments, mentors less experienced adjusters, and drives improvements in claims processes. The role ensures regulatory compliance and strategic outcomes that directly impact the organization''s risk management and service quality. 3. Responsibilities:Manage complex, high-exposure workers’ compensation claimsConduct detailed investigations into coverage, fraud, and compensabilityOversee medical case management for catastrophic and long-term injuriesReview and negotiate complex medical bills to control costsDevelop and implement return-to-work strategiesCalculate benefits accurately for high-exposure claimsLead fraud investigations and collaborate with special investigations unitsPerform subrogation analysis and negotiate recoveriesPartner with legal teams on settlements and litigationManage Medicare compliance including Set-Asides and CMS engagementIdentify and negotiate structured settlementsProduce strategic reports for management decision-makingMaintain data integrity and prepare for corporate action reviewsLead cross-departmental collaborations to improve claims handlingResolve escalated customer service issues and support key accountsMentor and coach junior and intermediate adjustersReview escalated claims and provide feedbackSupport workforce development and succession planning 4. Requirements:Bachelor’s degree in business or related field preferred, or equivalent experience7 to 10 years of experience handling workers’ compensation claimsPreferred designations: Associate in Claims (AIC), AIM, or CPCU, or willingness to obtainTexas All-Lines license preferredValid driver’s license required 5. Pay Range and Compensation Package:The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors. 6. Benefits & Perks:Medical, dental, and vision insurance including fertility benefits and adult orthodontiaEmployer-paid life insurance and disability benefitsWellness and recognition programs with incentivesFlexible spending and dependent care accountsHealth savings account with employer contributionsGenerous paid time off including holidays, volunteer time, and parental leaveEmployee assistance programs401(k) retirement plan with employer match and profit sharingAdoption and tuition assistance Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.