Workers Compensation, Claims Specialist in United States at Jobgether
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Job Description
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Workers Compensation, Claims Specialist based in the United States.
This role focuses on managing complex workers’ compensation claims from initial intake through resolution, ensuring fair, timely, and compliant outcomes for all parties involved.
You will investigate claims, determine compensability, and evaluate benefits in accordance with multi-state regulations and statutory requirements.
The position requires strong analytical thinking, negotiation skills, and the ability to balance customer service with cost and risk management.
You will interact regularly with injured workers, policyholders, medical providers, attorneys, and internal specialists to drive effective case outcomes.
A key part of the role involves maintaining accurate reserves, documenting claim activity, and ensuring regulatory reporting compliance.
You will operate in a fast-paced, autonomous environment where sound judgment and proactive decision-making are essential.
The role also supports return-to-work initiatives and continuous improvement of claims handling practices.
- Manage end-to-end workers’ compensation claims, including investigation, evaluation, reserving, negotiation, and resolution, while ensuring compliance with state-specific regulations and company guidelines.
- Determine compensability, benefits eligibility, average weekly wage, and benefit rates while securing required documentation and filing mandatory notices and reports.
- Conduct thorough investigations, coordinate medical reviews, utilize nurse case management, and support return-to-work initiatives to optimize claim outcomes.
- Monitor and adjust case reserves, manage litigation when necessary, and collaborate with legal counsel, medical experts, and recovery/subrogation teams.
- Ensure timely and accurate reporting, including Medicare obligations, reinsurance reports, and other regulatory or internal requirements.
- Identify fraud and subrogation opportunities while maintaining high-quality documentation in claims systems.
- Deliver consistent, professional communication and customer service to all stakeholders throughout the claim lifecycle.
- 3–5 years of experience handling workers’ compensation claims or similar insurance claims environment.
- Strong knowledge of insurance principles, claims handling practices, and workers’ compensation laws across multiple jurisdictions.
- Familiarity with medical terminology, legal procedures, and claims systems used for documentation and case management.
- Excellent analytical and decision-making skills, with the ability to interpret coverage, liability, and jurisdictional requirements.
- Strong negotiation, communication, and interpersonal skills for interacting with injured workers, attorneys, medical providers, and internal teams.
- Ability to manage complex workloads independently while maintaining accuracy and meeting deadlines.
- Bachelor’s degree in business administration or related field preferred, along with relevant certifications where applicable.
- Competitive salary range: $69,500 – $129,000 (starting range typically $69,500 – $103,500 depending on experience and location).
- Comprehensive medical, dental, and vision insurance coverage.
- Life insurance, short-term and long-term disability benefits.
- Paid time off, including a minimum of 18 days annually (pro-rated), plus paid holidays and additional personal leave.
- 401(k) retirement plan with company match and pension benefits.
- Hybrid/office-based flexibility depending on role requirements and location.
- Additional perks including paid training, professional development opportunities, and business casual work environment.
- Exposure to complex, high-impact claims work within a structured and supportive claims organization.