Senior Workers' Compensation Claims Specialist

Job Description

Job Description

Position Summary

Senior Workers’ Compensation Claims Specialist will service our multi-state clients’ workers’ compensation claims with little to no supervision required. This role requires that the claims specialist monitor their assigned employers’ workers’ compensation claims, from inception through closure, to ensure that all salient aspects of claim adjudication are being effectively and efficiently performed. This position will also be the main point of contact for client education on general work comp matters.

Essential Duties and Responsibilities

Lead comprehensive investigations of complex workers’ compensation claims, including in‑depth coverage analysis, compensability determinations, medical review, witness statements, and employer documentation, and provide detailed findings and strategic recommendations to the third‑party administrator (TPA) adjuster. Evaluate and respond to TPA requests for reserve and settlement authority, conducting advanced exposure assessments based on medical prognosis, statutory benefits, vocational factors, litigation risk, and historical claim patterns to ensure appropriately set reserves and fiscally sound settlement decisions. Perform sophisticated claim evaluations to determine potential financial and operational exposure, identifying high‑risk factors, potential red flags, subrogation opportunities, and long‑term cost drivers, and advising clients on proactive strategies to mitigate future loss. Serve as a high‑level consultant to clients on risk mitigation, analyzing claim trends, identifying systemic issues, recommending safety improvements, and developing strategies that reduce workplace injuries and claim frequency. · Provide empathetic and expert‑level communication to injured workers by offering clear guidance, answering complex questions, supporting their understanding of the claims process, and acting as a knowledgeable, compassionate advocate while balancing employer interests. Support clients in developing and optimizing return‑to‑work (RTW) programs, including identifying alternative/light‑duty assignments, evaluating functional capacity, and advising on transitional work opportunities to accelerate recovery and reduce indemnity costs. Act as a strategic liaison between clients, TPA adjusters, defense counsel, medical providers, and injured employees, ensuring coordinated case management, clear communication pathways, and reduced litigation exposure through early intervention and proactive engagement. Continuously monitor claim progression, ensuring timely action on medical updates, legal developments, benefit delivery, adjuster activity, and compliance with jurisdictional requirements, while identifying delays or inaccuracies that require escalation. Manage a portfolio of complex workers’ compensation claims from initial filing through closure, directing claim strategies, driving timely resolution, ensuring accurate documentation, and influencing case outcomes through expert guidance and oversight. Identify process improvements, leveraging data, claim trends, and client feedback to enhance the effectiveness of the workers’ compensation program and improve overall claim outcomes. Mentor and support junior claims staff, sharing expertise, offering case guidance, and contributing to the development of best‑practice procedures across the claims team. Regular attendance at the assigned work location for our corporate office locations is an essential job function. For team members who are located in or near the Chandler, AZ and Duluth, GA offices, this is an in-office position. Occasional domestic travel will be required to attend team onsite meetings, client visits, customer events, industry conferences, and training sessions. This may include air travel, ground transportation (including cars, taxis, or rideshare services), and in some cases potential public transportation. Build, maintain and promote relationships with team members, peers across disciplines, and all other company team members ensuring effective coordination of communications and services affecting clients. Attend webinars and training to stay up to date on best practices related to the company and department. Complete projects and other duties as assigned by supervisor. Knowledge, Skills, and Abilities

In‑depth knowledge of workers’ compensation laws, statutes, and regulations across multiple jurisdictions, with the ability to interpret complex legal and medical documentation. Expert understanding of claims investigation techniques, compensability analysis, coverage verification, and advanced risk assessment. Extensive knowledge of medical terminology, treatment guidelines, return‑to‑work principles, and rehabilitation processes to evaluate claim progression and exposure. Strong understanding of litigation processes, including legal strategy, attorney management, settlement negotiation, legal bill review, and mediation practices. Advanced knowledge of reserve setting and financial exposure analysis, including actuarial impacts, trend evaluation, and loss forecasting. Exceptional analytical and critical‑thinking skills, capable of interpreting complex claim data, identifying red flags, and developing sophisticated mitigation strategies. High‑level communication and interpersonal skills, including the ability to explain complex workers’ compensation concepts clearly to clients, executives, and injured employees. Strong negotiation skills, including settlement evaluation, dispute resolution, and strategic communication with attorneys and adjusters. Advanced case‑management and organizational skills, with the ability to manage a high‑volume or high‑complexity caseload while ensuring accuracy, compliance, and timely action. Proficiency in claims software, medical management systems, and data tools, including advanced Excel skills for reporting, trend analysis, and reserve reviews. Expert documentation and reporting skills, including the ability to prepare high‑quality claim summaries, risk analyses, and client advisories. Strong client‑relationship and consultative skills, supporting program development, training, and strategic risk reduction. Capable of working effectively under supervision while also demonstrating initiative and accountability in completing tasks independently. Maintains a strong work ethic, reliability, and commitment to excellence in all responsibilities, with a focus on integrity, confidentiality, and continuous improvement. Ability to build strong partnerships with clients, TPAs, medical providers, outside counsel, and internal teams to ensure coordinated and effective claims handling. Ability to provide compassionate, expert‑level guidance to injured workers, balancing advocacy with employer interests and legal compliance. Ability to maintain strict confidentiality and comply with HIPAA, legal requirements, and organizational policies at all times. Proficiency with Microsoft Office software (Outlook, Microsoft Teams, Excel, Word, PowerPoint) and demonstrated ability to learn other applications as needed. Education & Experience Bachelor’s degree preferred in Risk Management, Business Administration, Human Resources or equivalent combination of experience, skills, education (including other relevant non-traditional degree programs, certifications, or job training programs) preferred. 4-5 years of progressively responsible multi-state workers’ compensation claims experience, ideally in a third-party administrator (TPA), insurance carrier, or employer-based risk management environment. Demonstrated expertise managing complex, high-exposure, and litigated claims, including catastrophic injuries, long-term medical management, and settlement negotiations. Proven experience conducting in-depth investigations, evaluating compensability, analyzing medical documentation, and determining financial exposure. Experience collaborating with TPA adjusters, defense attorneys, medical providers, vocational professionals, and employer leadership. Strong background in return-to-work coordination, including developing light-duty programs and advising clients on transitional work strategies. Experience providing client consultation, program improvement recommendations, and training on workers’ compensation practices and regulatory compliance. Advanced professional designations such as Workers’ Compensation Claims Associate/Professional (WCCA / WCCP), Associate in Claims (AIC), Associate in Risk Management (ARM), Certified Workers’ Compensation Professional (CWCP) or Chartered Property & Casualty Underwriter (CPCU) are desired. Required Licenses And/Or Certifications Not Applicable Physical, Mental, & Communication Demands Physical Demands:

Sedentary Work: Occasionally involves sitting for extended periods, often at a desk or computer. Manual Dexterity: Frequent use of hands and fingers to operate a computer keyboard, mouse, and other office equipment. Mobility: Occasionally walking or traversing throughout the office to meet with leaders and other employees. Visual Acuity: Ability to read and analyze data on a computer screen (or to read and analyze data with reasonable accommodation) and in printed materials. Lifting & Carrying: Minimal physical lifting required, but may involve handling documents, and lifting light office supplies. Mental Demands: Strategic Thinking: High level of concentration required to develop and implement strategies. Decision Making: Ability to make quick, informed decisions based on data and market conditions. Attention to Detail: High level of accuracy needed for managing presentations, reports and communications. Problem-Solving: Continuous need to identify and resolve issues that may impact performance.

Multitasking: Manage multiple tasks and projects simultaneously, often under tight deadlines. Stress Management: Ability to handle high-pressure situations calmly and effectively, especially when dealing with client concerns. Communication Demands: Interpersonal Skills: Strong ability to build relationships and communicate effectively with employees, managers, clients, and external vendors. Cultural Sensitivity: Communicate with individuals from diverse cultural backgrounds, demonstrating cultural awareness and sensitivity. Written Communication: Prepare clear and concise documentation, including emails and notes. Verbal Communication: Conduct presentations and employee training sessions; provide clear instructions and support to clients, employees and managers. Environmental Conditions Indoor, office environment. May occasionally have moderate noise level from copiers, W2 or check printers, or co-workers.

Disclaimer This job description in no way states or implies that these are the only duties to be performed by the employee filling this position. Employee will be required to follow any other job-related instructions and to perform any other job-related duties requested by management. Management has the right to add to, revise, or delete information in this job description. Reasonable accommodation will be made to enable qualified individuals with disabilities to perform the essential functions of this position. This document does not create an employment contract, implied or otherwise, other than an “at will” employment relationship.

This position is eligible for the following benefits: Health Insurance: Medical, dental, and vision coverage Retirement Plan: 401(k) with company match Paid Time Off: PTO, Holidays, Parental leave and Sick Leave provided as required by applicable state law Other Benefits: Life insurance, short term disability, long term disability, employee assistance program (EAP), flexible spending account (FSA), health savings account (HSA), Identity theft protection, critical illness, accident, cancer, hospital protection, legal and pet insurance. Additional Compensation: [e.g., signing bonus, commission structure] if applicable

#SolvoHRGlobal

#LI-PROMOTED

#LI-Onsite

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.