Claims Management Specialist

Job Description

Job Description

Our client is in need of a bilingual Claims Management Specialist to support workers’ compensation administration in the78163, Bulverde, Texas area. This position focuses on guiding claims from the first notice of injury through final resolution while partnering with employees, clients, carriers, and internal teams to keep the process organized and responsive. The ideal candidate brings strong knowledge of workers’ compensation practices, clear communication skills in English and Spanish, and a service-oriented approach to claim coordination and return-to-work support.

Responsibilities:

• Oversee workers’ compensation cases throughout the full lifecycle, from initial incident intake to closure, ensuring timely follow-up and accurate handling at each stage.

• Act as the central point of contact for client representatives, injured employees, insurance partners, adjusters, medical offices, payroll, and human resources to keep claim activity moving efficiently.

• Explain claim procedures, reporting expectations, benefit-related steps, and return-to-work guidelines so all participants understand responsibilities and required actions.

• Prepare, organize, and maintain claim files, wage details, supporting records, and ongoing correspondence to promote complete and compliant documentation.

• Track case progress closely and work with carriers, employers, and care providers to address delays, support recovery efforts, and encourage productive claim outcomes.

• Participate in claim review discussions, assess status updates with adjusters and carriers, and help gather loss information and trend data for risk evaluation purposes.

• Support return-to-work coordination by aligning restrictions, communication, and next steps among stakeholders involved in each case.

• Deliver high-quality customer service by responding to questions promptly, clarifying next steps, and helping resolve claim-related concerns professionally.

• Keep required certifications current and assist with additional duties connected to claims administration and compliance as needed.

• Bilingual fluency in Spanish and English is required.
• Hands-on experience managing workers’ compensation claims, including documentation, communication, and claim follow-through.
• Working knowledge of OSHA regulations, workplace safety standards, and accident prevention principles.
• Familiarity with benefits-related processes such as leave administration, wage reporting, or FMLA coordination.
• Ability to maintain accurate records and organize sensitive claim information with a high degree of attention to detail.
• Understanding of insurance and claims management practices, including collaboration with carriers, adjusters, and medical providers.
• Strong written and verbal communication skills with the ability to explain processes clearly to multiple audiences.