Workers' Compensation Claims Specialist (REMOTE - ME, CT, NJ)

About the role

Creative Risk Solutions (CRS) is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. We are seeking a Workers’ Compensation Claims Specialist to join our team.

Essential Responsibilities

• Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner.
• Investigates, evaluates, and resolves lost time Workers’ Compensation claims, including litigated claims.
• Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage issues.
• Enters and maintains accurate information on a computer system during the claim process, to include final settlement information.
• Generates checks for indemnity and medical payments daily.
• Develops and monitors consistency in procedural matters of claims handling process within CRS.
• Willingness to become licensed if required in jurisdiction where claims are handled.

Qualifications

• Education: High school diploma; college degree preferred.
• Experience: 3-5 years claims experience with strong background in Workers’ Compensation claims handling. Prior experience handling Maine, Connecticut, and New Jersey claims is required.
• Licensing: Active Maine, Connecticut, and/or New Jersey Workers' Compensation License required or the ability to acquire license within three months of hire.

Skills

• Proficient knowledge of Workers’ Compensation insurance coverage and claims processing procedures.
• The ability to adjudicate lost time claims across multiple jurisdictions and demonstrate the capacity to quickly learn and adapt to various software programs.
• A strong grasp of claims principles, practices, and insurance coverage interpretation, contributing to workflows and adhering to compliance requirements.
• The ability to prioritize problem-solving, actively foster relationships, and collaborate to deliver impactful solutions and a world-class client experience.

Benefits

• Core benefits: Health, dental, and vision insurance.
• Additional benefits: Paid Parental Leave, supportive New Parent Benefits, Company-paid continuing Education & Tuition Reimbursement, 401k Profit Sharing, Generous time off practices, Paid Volunteer time off, Employee matching gifts to charities, Supportive of community efforts, Consistent merit increase and promotion opportunities, Discretionary bonus opportunity.

Pay

$57,500– $98,900. Compensation is based on several factors, including, but not limited to, education, work experience and industry certifications.

Schedule

N/A