Workers' Compensation Specialist

JOB SUMMARY:

A Workers' Compensation Specialist oversees the entire process of handling workplace injury claims, ensuring that all necessary documentation is accurately completed and submitted in compliance with state and federal laws. They serve as the main point of contact between injured employees, insurance providers, medical professionals, and the employer, coordinating care and claim resolutions. Their duties include tracking claim progress, maintaining detailed records, managing deadlines, and supporting return-to-work efforts when appropriate. By ensuring timely and compliant processing of claims, they help protect both the employee's rights and the employer's legal and financial interests.

JOB RESPONSIBILITIES

ESSENTIAL FUNCTIONS:

• Manage all internal workers' compensation claims from initial report through closure.
• Serve as the point of contact between employees, managers, providers, insurers, and TPAs.
• Track and monitor claims; coordinate return-to-work plans and maintain open communication throughout the process.
• Implement and lead return to work program.
• Maintain organized claim files and prepare detailed reports on claims activity, trends, and costs for internal stakeholders.
• Lead training sessions for supervisors and staff on workers' comp processes and injury prevention.
• Participate in safety audits, risk analysis, and performance metrics reviews.
• Leave of Absence Support (Secondary/Backup Responsibility)
• Maintain knowledge of FMLA, ADA, and state-specific leave laws.
• Serve as backup to the LOA Administrator during busy periods, absences, or escalated cases.
• Support employee communication, documentation, and leave tracking when needed.
• Coordinate with HR and payroll to ensure proper documentation and compliance.
• Systems, Reporting & Implementation
• Create and maintain regular reports on claim trends, costs, and outcomes to support decision-making.
• Assist in software transitions, upgrades, or implementations related to claims or HR systems.
• Collaborate with internal teams and vendors to test and roll out system improvements.
• Demonstrate comfort learning and using a variety of platforms, including claims management systems, HRIS, and reporting tools.
• Compliance, Communication & Collaboration
• Ensure compliance with all federal, state, and internal policies related to WC and LOA.
• Handle sensitive information with discretion and professionalism.
• Maintain a people-first approach while upholding legal and policy standards.
• Work closely with HR, Legal, Safety, and management teams across multiple states.
• Must become familiar with and have a working knowledge of the Human Resources Policies and Procedures and job descriptions.
• Perform all job responsibilities in alignment with the industry's best security practices and regulatory guidelines to protect the confidentiality, integrity, and availability of protected health information and other sensitive company data.
• Must be familiar with and abide by the Corporate Compliance Program and all corporate policies, including the Privacy and Security policies.

NON-ESSENTIAL FUNCTIONS:

• Work with other departments within PathGroup and subsidiaries.
• Nothing in the job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
• Other duties as assigned.

EDUCATION & LICENSURE:

• Bachelor's Degree or equivalent experience preferred.

REQUIREMENTS:

• Healthcare experience preferred.
• At least two to five years of Workers' Compensation experience required.
• Knowledge of State and Federal employment law/regulations and general principles and practices of human resources required.
• Ability to travel to on-site investigations as required.