Sr. Work Comp Claims Rep

Senior Workers' Compensation Claims Representative

Compensation: $80,000$100,000

We are seeking an experienced Senior Workers' Compensation Claims Representative to manage assigned claims from initial reporting through resolution. This role is responsible for conducting thorough investigations, evaluating coverage and liability, coordinating with claimants and medical providers, and ensuring claims are handled accurately, efficiently, and in accordance with established service standards.

Key Responsibilities

• Manage assigned workers' compensation claims from initial report through final resolution , ensuring timely and accurate claim handling.
• Secure and document all required claim information for the claims file and management review.
• Conduct prompt follow-up with claimants by telephone or written correspondence to obtain missing information and ensure all necessary documentation is received.
• Obtain information from witnesses, physicians, medical providers, employers, and other involved parties to fully investigate assigned claims.
• Secure medical records, medical bills, wage information, and other documentation necessary to evaluate and resolve claims.
• Investigate the facts and circumstances surrounding each claim and conduct field investigations when appropriate.
• Evaluate coverage, compensability, liability, damages, and other factors necessary to determine appropriate claim action.
• Establish appropriate claim reserves and request/authorize payments within established authority levels.
• Issue claims payments when appropriate and ensure all required documentation is completed and maintained.
• Work closely with claimants, employers, medical providers, attorneys, and other stakeholders to facilitate timely and equitable claim resolution.
• Maintain accurate, thorough, and up-to-date claim files and documentation.
• Ensure all assigned claims meet established service standards, regulatory requirements, and internal procedures .
• Identify opportunities to resolve claims efficiently while maintaining a focus on accuracy, compliance, and quality customer service.
• Provide management with required claim documentation, reports, and updates for tracking and oversight.
• Assist with special projects and perform other duties as assigned.

Qualifications

• 5+ years of workers' compensation claims experience , preferably handling claims independently from first notice through resolution.
• Strong knowledge of workers' compensation claim investigation, evaluation, coverage, and settlement practices.
• Demonstrated ability to investigate complex claims and gather information from multiple sources.
• Strong analytical, decision-making, negotiation, and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to manage a high-volume caseload while maintaining accuracy and meeting established deadlines.
• Strong organizational skills and attention to detail.
• Proficiency with claims management systems and Microsoft Office.
• Ability to work independently while collaborating effectively with internal teams, employers, medical providers, attorneys, and other stakeholders.
• Active adjuster license or applicable state licensing/certification preferred , depending on jurisdiction.

What We Offer

• $80,000$100,000 salary range
• Opportunity to join a professional and collaborative claims team
• Challenging and diverse workers' compensation caseload
• Career growth and professional development opportunities
• Competitive benefits package
• A role with meaningful responsibility and the opportunity to make a direct impact on claim outcomes and client service

To be considered, please submit a resume to View email address on click.appcast.io and reference: Sr. Work Comp Claims Rep