Workers' Claims Specialist

We’re currently seeking a Workers' Compensation Claims Specialist to join our Headquarters team!

The Workers’ Compensation Claims Specialist is responsible for managing workers’ compensation claims from initial report through resolution. This role ensures claims are handled accurately, timely, and in compliance with applicable laws, regulations, and organizational policies while balancing cost control with appropriate employee care and return-to-work outcomes.

Claims Management:

• Receive, review, and investigate workers’ compensation claims to determine compensability.
• Establish and manage claim files, documenting all actions, communications, and decisions.
• Oversee the TPA’s coordination of medical treatment, disability benefits, and settlements in accordance with statutory requirements.
• Monitor claim progress and investigate reserves to ensure appropriateness based on claim developments.

Coordination & Communication:

• Serve as the primary point of contact for injured employees, supervisors, medical providers, attorneys, and third-party administrators.
• Communicate claim status, rights, and responsibilities clearly and professionally to all stakeholders.
• Collaborate with HR, Risk Management, Safety, and Legal teams to support effective claim outcomes.

Investigation & Evaluation:

• Conduct claim investigations, including reviewing incident reports, medical records, wage information, and witness statements.
• Identify potential fraud, subrogation, or recovery opportunities and escape as appropriate.
• Evaluate claim exposure and recommend strategies for resolution.

Return-to-Work & Cost Containment:

• Support return-to-work and transitional duty programs in partnership with employers and medical providers.
• Identify opportunities to reduce claim duration and overall cost while supporting employee recovery.
• Participate in claim reviews, audits, and loss analysis activities.

Compliance & Documentation:

• Ensure claims handling complies with federal, state, and local workers’ compensation laws and regulations.
• Maintain accurate, complete, and timely documentation in claims management systems.
• Prepare required regulatory filings, reports, and correspondence including Bureau of Labor Statistics (BLS) surveys.
• Coordinate required OSHA reporting and maintain compliance with OSHA recordkeeping requirements.
• Oversee the transfer of claim and incident data into appropriate systems for the timely and accurate generation of OSHA Forms 300 and 300A.
• Coordinate the preparation, distribution, and annual posting of OSHA Form 300A.

Note:

The job duties above provide a general sense of the role; though, additional duties may be assigned as necessary.

Education:

• Associate’s degree in healthcare administration, risk management, business or a related field or equivalent experience.

Experience:

• 2–5 years of workers’ compensation claims handling experience.

Knowledge, Skills, & Abilities:

• Strong working knowledge of workers’ compensation laws, medical terminology, and claims best practices.
• Proficiency with claims management systems and standard office software.
• Ability to manage multiple claims and deadlines in a fast-paced environment.
• Excellent analytical, organizational, and time-management skills.
• Effective written and verbal communication skills, with the ability to handle sensitive situations empathetically.
• Detail-oriented with strong judgment and decision-making ability.
• Professional, ethical approach to claim handling and confidentiality.
• Collaborative mindset with the ability to work independently.