Workers Compensation and Risk

JOB SUMMARY

The Workers’ Compensation and Risk Specialist III is responsible for managing complex workers’ compensation claims and serving as a subject matter expert for the organization’s workers’ compensation program. This role leads high-exposure claim strategies, partners cross-functionally to reduce risk, and drives continuous improvement in claim outcomes, cost containment, and employee experience. The Specialist III also plays a key role in enterprise risk management initiatives and mentors junior team members.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Claims Management & Strategic Oversight

• Manage the full lifecycle of workers’ compensation claims, including complex, high-exposure, litigated, and multi-jurisdictional cases

• Serve as escalation point for challenging claims, providing guidance on compensability, reserves, and settlement strategy

• Develop and implement claim strategies to optimize outcomes, minimize risk exposure, and control total cost of risk

• Lead regular claim reviews with TPAs, carriers, and internal stakeholders to ensure proactive claim handling

• Establish appropriate reserves and approve settlements within expanded authority guidelines

• Identify trends, root causes, and opportunities for systemic improvements in claim handling

Business Partnership & Program Leadership

• Act as a trusted advisor to HR, Operations, Safety, and Leadership on workers’ compensation matters

• Partner with safety teams to identify injury trends and implement prevention strategies

• Lead return-to-work program effectiveness, including modified duty strategy and vendor optimization

• Ensure compliance with all state workers’ compensation laws and OSHA requirements

• Provide guidance during audits, litigation, and regulatory inquiries

Risk Management & Continuous Improvement

• Support and influence enterprise risk management initiatives related to occupational risk

• Analyze claim data and produce insights to inform leadership decision-making

• Recommend process improvements, automation opportunities, and policy enhancements

• Participate in insurance renewal strategy, including providing loss data analysis and insights

Mentorship and Leadership

• Mentor and provide guidance to Specialist I and II roles

• Support onboarding and training of new team members

• Lead or contribute to cross-functional projects and initiatives

JOB QUALIFICATIONS: Education & Experience Requirements

Skills and Competencies

• Advanced knowledge of workers’ compensation laws, claims handling, and injury management

• Strong analytical and problem-solving skills with ability to interpret complex data

• Demonstrated negotiation and influencing skills in high-stakes situations

• Ability to manage ambiguity and lead through complex claim scenarios

• Strong communication and stakeholder management skills

• Advanced proficiency in claims systems, RMIS, and Microsoft Office tools

________________________________________

EDUCATION & EXPERIENCE

• Bachelor’s degree or equivalent experience required

• 5–8 years of workers’ compensation or risk management experience required

• Professional certification, in at least one State (e.g., CPCU, ARM, AIC, or Workers’ Compensation certification) required

• Experience handling high-volume and high-complexity claims environments required

#app2