Claims Specialist

General Description

The Wyoming Department of Workforce Services is seeking a detail-oriented and analytical Claims Specialist to join its Workers’ Compensation team. In this role, you will perform comprehensive case management functions for assigned employer accounts, ensuring the timely and accurate handling of Workers’ Compensation claims. Responsibilities include determining the compensability of claims based on statute and policy, reviewing documentation, analyzing facts, and making sound, well-supported decisions.

The position also monitors claims activity for potential fraud, abuse, or other improprieties, helping safeguard the integrity of the Workers’ Compensation program. This role requires strong critical thinking skills, attention to detail, and the ability to communicate clearly and professionally with employers, injured workers, medical providers, and other stakeholders. If you are committed to public service and take pride in ensuring fair, consistent, and accountable claims administration, we encourage you to apply.

• Use case management skills to guide customers through the Workers' Compensation benefits program.
• Review injury reports.
• Investigate the circumstances of the injury.
• Make eligibility determinations on the claim for benefits by reviewing applications and medical reports.
• Process claims for indemnity benefits.
• Communicate clearly the rights, responsibilities, and benefits of the Workers' Compensation program.
• Assist injured workers with filing requirements and understanding the complex claims processes.
• Refer appropriate cases for hearing, and may provide testimony in the hearings.
• Respond directly to employers or vendors regarding questions on procedures or the status of cases or claims.
• Coordinate return to work and work restrictions with healthcare providers and employers.
• Analyze medical documentation to determine the compensability of claims.
• Initiate and monitor program requirements and process benefits.
• Mediate disputes involving injured workers, employers, healthcare providers, and the division.
• Coordinate with healthcare providers to effectively manage the compensable injury and establish appropriate diagnoses and treatment plans for the injury.

Preferences: Preference may be given to those with Claims Management and/or Claims Service experience, Customer Service experience, or a Bachelor's degree in Management and/or Social Services.

Knowledge:

• Knowledge of Workers' Compensation Law and Rules & Regulations.
• Ability to assist clients in working through complex processes.
• Ability to work independently.
• Ability to analyze situations and provide resolutions within the statutes.
• Knowledge of medical terminology.
• Knowledge of case management.
• Knowledge of customer service.

Education: Minimum Qualifications:
Bachelor’s Degree.

Experience:

• 0–1 year of progressive work experience (typically in Benefits and Eligibility), or
• 3–4 years of progressive work experience (typically in Benefits and Eligibility) as a substitution for education.

Certificates, Licenses, Registrations: None.

Special Requirements:

• FLSA:
  Non‑Exempt.
• Former State of Wyoming employees rehired within 31 days of their previous employment must repay all leave payouts.
• The Wyoming Department of Workforce Services uses E‑Verify to confirm eligibility to work in the United States.
• Veterans' preference requires supporting documentation to be submitted with the application.
• Offers of employment will be contingent upon the successful completion of a background check.

• Comprehensive health, dental, and vision insurance.
• Paid vacation, sick leave, FMLA and holidays.
• Retirement – Pension and 457B plans.
• Flexible schedules and work‑life balance options.
• Meaningful work that makes a difference for Wyoming communities.
• Voluntary benefits including life insurance, ambulance, pet insurance, short/long‑term disability, flex spending and health savings accounts.
• Multiple retirement options, including the Wyoming Retirement System and a 457B account.
• Generous paid leave and flexible schedules – vacation, sick leave, paid FMLA and 11 paid holidays each year.
• Public Service Loan Forgiveness eligibility.
• Training and professional development.
• Employee Assistance Program.
• Wellness Program – Earn paid time off and incentives by focusing on your personal health.

Explore your total compensation: (Use the "Apply for this Job" box below)..gov

Human Resource Contact: kelly.gayer

The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities. The State of Wyoming is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, veteran status or any other characteristic protected by federal or state law. The State of Wyoming also provides a veteran's preference as described above.