Workers Comp Claim Specialist

Job Description

Job Description

Position Summary The Workers' Compensation Claim Specialist manages the full lifecycle of workers' compensation claims for PEO client companies, from first report of injury through closure. This role serves as the primary point of contact between clients, carriers, adjusters, and the internal Risk Management (RM) team, ensuring every claim is reported accurately, documented thoroughly, and resolved in line with best practices. The Specialist also supports client onboarding, regulatory compliance, carrier reporting, and risk and safety education.

Key Responsibilities

Claims Management

• Receive, review, and file new workers' compensation claims with the appropriate carrier, copying the RM team on all communications
• Set up and maintain claim files in the CHR management system and PRISM
• Provide adjusters with complete claim documentation and file all ongoing correspondence in the claim record
• Coordinate with clients, adjusters, and the RM team on medical appointments, treatment records, and return-to-work status
• Track drug test results and communicate outcomes to the RM team, adjuster, and client
• Calculate wage statements for claim processing
• Monitor open claims, follow up on pending items, and resolve claim-related issues and inquiries

Client Onboarding & Risk Support

• Introduce new clients to RM policies and procedures
• Distribute and review the RM claim kit, including claim reporting requirements, return-to-work program, chain of custody forms, and physician panels
• Conduct initial risk and safety orientations, explaining available risk services and client PEO responsibilities
• Advise clients on how risk and safety issues affect their business
• Develop and deliver workers' compensation presentations and training

Compliance & Reporting

• Notify the state, carriers, and RM team of new and terminated clients
• Prepare and submit required reports to workers' compensation carriers
• Prepare reports for monopolistic state workers' compensation policies
• Compile and distribute OSHA log data to clients
• Provide clients with OSHA and regulatory updates, including education on changes
• Research and stay current on workers' compensation legislation and regulations

Administrative & Cross-Team Support

• Issue certificates of workers' compensation insurance promptly upon client request and coordinate billing with Accounting
• Maintain the client contact list and claim fee spreadsheet
• Draft, edit, and proofread claim correspondence, reports, and client materials
• Document all client interactions per departmental guidelines
• Support the PEO underwriting team, vendor partners, field service staff, Sales, and HR as a workers' compensation resource
• Analyze recurring claim and process issues and recommend improvements

Qualifications

• 1–2 years of workers' compensation claims experience, preferably in a PEO environment (required)
• 1 year of administrative experience in a fast-paced business environment
• PRISM experience (preferred)
• Proficiency in Microsoft Excel (required), Word, and Outlook
• High school diploma required; associate degree preferred

Skills & Abilities

• Working knowledge of workers' compensation claim processes, carrier requirements, and OSHA recordkeeping
• Ability to manage a high volume of claims and deadlines simultaneously
• Strong analytical, problem-solving, and decision-making skills
• Clear, professional communication with injured workers, clients, adjusters, and carriers
• Excellent organization, attention to detail, and documentation habits
• Collaborative approach within a team environment