Claims Specialist

Job Description

Job Description

Description:

GENERAL SUMMARY:

Reporting to the Senior Manager of Safety and Risk, the Claims Specialist is responsible for overseeing employee injury claims and general liability claims and coordinating care, recovery, and insurance processes. They serve as the primary point of contact between injured employees, healthcare providers, management, insurers, and third parties, ensuring timely communication and claim resolution. Responsibilities include reviewing treatment plans, monitoring recovery progress, managing return-to-work programs, controlling claim costs, maintaining accurate documentation, and ensuring compliance with workers’ compensation and liability regulations. Overall, the role supports efficient claim management, cost control, and positive recovery outcomes.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Manage the workers’ compensation and general liability claims process from reporting through resolution.
• Review incident and injury reports, ensuring accurate, timely, and compliant documentation.
• Report injuries to the workers’ compensation carrier and maintain ongoing claim communication.
• Coordinate communication between injured employees, employers, insurance carriers, medical providers, attorneys, external vendors and third parties.
• Meet with injured employees to assess recovery progress, work restrictions, and return-to-work needs.
• Monitor medical treatment, recovery progress, and work restrictions to ensure appropriate care and timely claim resolution.
• Evaluate and communicate work restrictions to supervisors and management.
• Facilitate return-to-work and interactive process activities, including modified or alternative duty assignments in compliance with applicable laws.
• Identify and address barriers, delays, or compliance issues impacting recovery or claim outcomes.
• Track claim activity, deadlines, hearings, depositions, and required follow-up actions.
• Maintain detailed case files, reports, and documentation in accordance with company policies and regulatory requirements.
• Support cost containment efforts by managing appropriate care, reducing delays, and monitoring return-to-work timelines.
• Assist management with workplace injury investigations, reporting procedures, and employee injury response.
• Train and support management staff on injury reporting and claims procedures as needed.
• Compile workers’ compensation data and maintain reporting for compliance reviews and claim meetings.
• Participate in claim settlement discussions and support timely claim closure strategies.
• Analyze claim trends and injury data to support risk reduction and workplace safety initiatives.
• Prepare reports and metrics related to claim activity, costs, and return-to-work outcomes for leadership review.
• Assist with OSHA reporting, regulatory compliance, and audit preparation as required.
• Serve as a resource for workers’ compensation and liability claims across all company locations.
• Ensure compliance with workers’ compensation laws, liability regulations, company policies, and safety standards.
• Promote workplace safety, teamwork, and effective communication throughout the claims process.

Additional Responsibilities

• Always act safely and maintain confidentiality of sensitive employee medical and claim information in accordance with HIPAA and company standards.
• Provide medical referrals and support to employees.
• Work independently with sound judgment.
• Perform other duties as assigned.

QUALIFICATIONS:

Basic Qualifications of the Role:

• Must be 18 years of age or older.
• One to three years’ equivalent work experience.
• Knowledge of workers’ compensation claims processes, general liability claims, workplace injury reporting procedures, and applicable local, state, and federal laws.
• Strong verbal and written communication skills with the ability to effectively interact with employees, management, medical providers, insurance carriers, attorneys, and third parties.
• Ability to handle sensitive and confidential information with professionalism and discretion.
• Strong organizational, time management, and problem-solving skills with the ability to manage multiple priorities and meet deadlines.
• Familiarity with workplace safety practices, incident investigations, and regulatory compliance requirements.
• Proficiency in Microsoft Office applications, email, spreadsheets, and claims or reporting systems.
• Ability to work independently, exercise sound judgment, and maintain effective working relationships in a team-oriented environment.
• Able to provide own transportation as required.
• Must be able to function independently in a work setting.
• Must pass drug screening and criminal background check.
• Must possess a valid California driver’s license and insurable driving record.
• Must not pose a direct threat to the health or safety of self, others, or company property.
• No record or disclosure of criminal conviction that indicates a tendency toward theft, violence, dishonesty, deceit, drug use, moral turpitude or predatory behavior in conflict with the functions listed within this job description.
• Must immediately inform Supervisor of any arrests and/or convictions that occur while employed at Goodwill.
• Must provide proof of identification and eligibility to work in the United States.
• Able to perform the duties of the position with or without reasonable accommodation.
• Must be able to demonstrate upon request functional literacy and numeracy.
• Must meet Goodwill quantitative and qualitative performance standards.

Preferred Qualifications for the Role:

• Experience in claims management, retail operations, human resources, workplace safety, risk management, and/or administrative support roles preferred.
• Understanding of return-to-work programs, modified duty assignments, and the interactive process preferred.

POSITION INFORMATION:

This position is a full time, non-exempt position eligible for Medical, Dental, Vision, Life Insurance; 403(b) retirement plan; Paid Vacation and Sick Leave. This position is employed by Goodwill Industries® of Sacramento Valley and Northern Nevada, Inc.

POSITIONS SUPERVISED:

• None

WORK CONDITIONS/HAZARDS:

• Work is divided between office and field environments.
• Hazards may include higher than normal chance of exposure to communicable diseases and to known and unknown hazardous chemicals.
• High adaptability required.
• Work environment is usually hectic (fast-paced) with frequent short deadlines and regular instances of critical or unusual situations.
• Travel to various company locations is required.

The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to drive, stand, walk, sit, use hands and fingers, handle or feel objects, reach with hands and arms, climb or balance, stoop, kneel, crouch or crawl and talk or hear. The employee must be able lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds. Work environment is usually hectic/fast paced with regular instances of critical or unusual situations. Travel to various company locations may be required. The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.

This job description does not cover all the activities, duties or responsibilities required of this role. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice to accommodate the needs of the organization. The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change