Senior Claims Specialist

Our client operates in the risk management sector, specializing in workers’ compensation, auto, health, and disability management. The organization addresses challenges related to managing claims and controlling costs through integrated solutions supported by technology and human capital. With a national presence and over 4,000 employees, the company fosters a culture centered on accountability, commitment, excellence, integrity, and teamwork.

About the Role

This position manages complex and high-profile workers’ compensation claims to achieve optimal outcomes. The Senior Claims Specialist collaborates with case managers and attorneys, handles subrogation and settlements, and supports the Claims Department’s objectives to control claim costs and ensure customer satisfaction.

Responsibilities

• Receive workers’ compensation claims and confirm policy coverage
• Investigate claim validity and compensability, filing required state documentation
• Establish reserves and authorize payments within authority limits
• Develop and manage action plans with case and outcomes managers to reduce claim costs
• Coordinate early return-to-work efforts
• Manage subrogation and litigation processes
• Oversee potential claim recoveries
• Report claims to excess carriers as applicable
• Communicate claim status with customers and claimants
• Adhere to client and carrier guidelines and participate in claim reviews
• Maintain professional customer relationships
• Comply with applicable state rules and regulations
• Perform additional duties as assigned

Requirements

• Bachelor’s degree or equivalent education and related experience
• Minimum of 3 years’ industry experience and claim handling
• Self-Insured Certificate preferred
• State certification or license as an experienced claims adjuster
• Current license or certification in workers’ compensation maintained throughout employment
• Excellent written and verbal communication skills
• Ability to support team knowledge development
• Strong problem-solving skills
• Proficiency with Microsoft Office, including Excel
• Strong interpersonal, time management, and organizational skills
• Ability to work independently and in a team
• Knowledge of claims administration, case management, and cost containment in workers’ compensation

Pay

Pay range: $61,053 to $98,334, determined by factors including location, skills, experience, qualifications, and market conditions.

Benefits

• Medical insurance (HDHP) with pharmacy
• Dental insurance
• Vision insurance
• Long-term disability
• Health savings and flexible spending accounts
• Life, accident, and critical illness insurance
• Pre-paid legal insurance
• Parking and transit FSA accounts
• 401(k) and ROTH 401(k)
• Paid time off