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We are looking for a fully remote Senior Workers’ Compensation Claims Specialist to assist our client with a long-term project. This person will be responsible for managing a complex caseload of workers’ compensation claims from inception through resolution. This role ensures compliance with applicable laws and regulations, delivers excellent customer service, and works closely with internal stakeholders, injured employees, medical providers, and legal counsel to facilitate timely and cost-effective claim outcomes.
Job Responsibility:
Manage a portfolio of high-exposure and complex workers’ compensation claims, including litigated cases
Investigate claims by reviewing reports, medical records, and conducting interviews to determine compensability
Ensure timely and accurate claim adjudication in accordance with state laws and company guidelines
Develop and execute claim strategies, including reserve setting and ongoing reserve adjustments
Coordinate with medical providers, rehabilitation specialists, and case managers to support return-to-work initiatives
Monitor and manage litigation, working closely with defense attorneys and attending hearings, mediations, and depositions as needed
Communicate regularly with injured employees, employers, brokers, and other stakeholders regarding claim status
Requirements:
Hold a valid New York adjuster's license
Manage a complex caseload of workers’ compensation claims from inception through resolution
Ensure compliance with applicable laws and regulations
Deliver excellent customer service
Work closely with internal stakeholders, injured employees, medical providers, and legal counsel