Workers Compensation Claims Specialist

Job Description We are looking to add a Essential Responsibilities Adjudicate claims during staffing shortages, investigate, and negotiate settlements per “Best Practices for Claims.” Monitor and document claim files, focusing on Coverage, Investigation, Reserves, Plan of Action, Legal, and Medical Management. Recommend adjustments as needed. Research and respond to questions and complaints from insureds, claimants, agency partners, and fronting carriers. Discuss complex claims and coverage issues with clients, addressing any inquiries. Maintain communication with customers and fronting carriers per “CRS Communication Expectations” and “Reportable” file guidelines. Assist staff in managing litigation claims, ensuring timely responses and protecting the interests of insured and carriers. Job Description We are looking to add a Sr. Workers’ Compensation Claims Specialist, Supervisor to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in multiple states. This team member will provide high quality claims handling oversight and expertise for all CRS customers on litigated and complex claim situations. This includes assisting staff supervised with investigating, communicating, evaluating, and resolving claims utilizing the CRS Best Practice of Claim Handling. Assisting claim staff with goals, career pathing, and ensuring engagement. Essential Responsibilities Adjudicate claims during staffing shortages, investigate, and negotiate settlements per “Best Practices for Claims.” Monitor and document claim files, focusing on Coverage, Investigation, Reserves, Plan of Action, Legal, and Medical Management. Recommend adjustments as needed. Research and respond to questions and complaints from insureds, claimants, agency partners, and fronting carriers. Discuss complex claims and coverage issues with clients, addressing any inquiries. Maintain communication with customers and fronting carriers per “CRS Communication Expectations” and “Reportable” file guidelines. Assist staff in managing litigation claims, ensuring timely responses and protecting the interests of insured and carriers. Management Responsibilities Team Leadership Ensure appropriate staffing, including hiring and terminations. Coach team members on workflow, processes, customer service, and client consulting. Conduct performance reviews, set goals, and hold employees accountable. Foster career development and manage timesheets and compensation decisions. Team Coordination Facilitate regular team meetings and attend enterprise and leadership training. Coordinate training and maintain standardized processes for quality service. Provide backup assistance as needed. Additional Responsibilities Conduct monthly performance meetings and quarterly team meetings. Set and monitor annual goals for staff. Participate in round tables, claim reviews, and Risk Control Workshops. Mediate between insured and insurance company, addressing coverage issues and large loss reporting. Analyze performance data to implement necessary changes. Review all files at least every 90 days. Qualifications Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. Experience: 5+ years of adjusting property and casualty claims, including litigated claims. Prior agency, loss control or carrier experience preferred. Prior supervisory experience preferred. Licensing: Active state specific Workers Compensation License required or the ability to acquire license within three months of hire. Skills: Extensive knowledge of General and Auto Liability or Workers Compensation coverages and application in job duties, proficient in claims processing procedures, knowledge or ability to learn multiple state insurance regulations; pass state licensing exams. Technical Competencies: An ideal candidate will have a strong grasp of claims principles, practices, and insurance coverage interpretation, contributing to workflows and adhering to compliance requirements. They will prioritize problem-solving, actively foster relationships, and collaborate to deliver impactful solutions and a world-class client experience. Here’s a Little Bit About Us Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies. In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization\'s success by effectively influencing and uplifting team members. Benefits Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: Paid Parental Leave and supportive New Parent Benefits — We know being a working parent is hard, and we want to support our employees in this journey! Company paid continuing Education & Tuition Reimbursement — We support those who want to develop and grow. 401k Profit Sharing — Each year, Holmes Murphy makes a lump sum contribution to every full-time employee’s 401k. This means, even if you’re not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. Generous time off practices in addition to paid holidays — Yes, we actually encourage employees to use their time off, and they do. After all, you can’t be at your best for our clients if you’re not at your best for yourself first. Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you — Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. Inclusion & Belonging Programs — Holmes Murphy is committed to celebrating every employee’s unique potential. Through inclusion and belonging initiatives, titled Uniquely United, not only do we offer employees a paid Diversity Day time-off option, but we also have a Uniquely United Committee, Employee Resource Groups, and development programs to advance our culture of belonging. We encourage employees to engage in ways that are meaningful to them to enhance their overall experience! Consistent merit increase and promotion opportunities — Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important — not only with your financial wellbeing, but also your career wellbeing. Discretionary bonus opportunity — Yes, there is an annual opportunity to make more money. Who doesn’t love that? The salary range for this role is $75,000– $125,000. Compensation is based on several factors, including, but not limited to, education, work experience and industry certifications. In addition to your salary, Holmes Murphy offers a comprehensive total rewards program including annual bonuses, total wellbeing benefits and support for professional development. Holmes Murphy & Associates is an Equal Opportunity Employer. #J-18808-Ljbffr