[Hiring] Workers Compensation Claims Specialist @Employbridge

Role Description

The Workers’ Compensation Claims Specialist plays a key role in supporting Risk Management’s objective of optimizing the organization’s cost of risk by managing complex workers’ compensation claims. This role requires a deep understanding of claims processes, strong communication skills, and the ability to coordinate with internal and external stakeholders to ensure timely and effective resolution.

• Actively and consistently supports all efforts to simplify and enhance the customer experience.
• Demonstrates a strong customer service focus by building sustainable relationships with internal and external stakeholders through proactive and interactive communication.
• Maintains composure and handles difficult situations diplomatically and professionally.
• Manages a portfolio of legacy, multi-jurisdictional workers’ compensation claims with a focus on timely and cost-effective resolution.
• Proactively develops claim strategies based on factors such as injury type, jurisdiction, body part, and claimant profile in alignment with Employbridge standards and best practices.
• Ensures accurate and timely establishment of claim reserves to support stable actuarial studies.
• Drives claim closures to minimize financial exposure and improve claim outcomes.
• Maintains thorough and timely documentation in the internal RMIS system, capturing medical, legal, and claim developments to ensure accountability with third-party administrators (TPAs).
• Participates in scheduled claim reviews with TPAs to maintain alignment on reserves, action plans, and resolution strategies with adjusters, nurse case managers, and attorneys.
• Assists team members with wage verification and wage statement requests.
• Prepares and sends necessary notifications to branch managers following resignation or release check requests.
• Assists in resolving claims reported with an unknown location to ensure accurate reporting and processing.
• Manages electronic mail distribution for the Risk Services department to ensure timely routing of information and requests.

Qualifications

• High school diploma or GED required; Associate's or Bachelor's degree preferred.
• Experience in risk management, insurance, or a related field strongly preferred.
• Staffing industry experience preferred.
• Bilingual in English and Spanish preferred.

Requirements

• Proficient in MS Word, Excel, Outlook, and eager to learn new systems and platforms.
• Strong analytical and problem-solving skills; able to evaluate multiple options and select appropriate actions.
• Adaptable and quick to learn new concepts in a fast-paced, changing environment.
• Excellent verbal and written communication; able to tailor communication style to various audiences.
• Demonstrates integrity and ethical behavior in all interactions.
• Sound judgment and decision-making skills, balancing risks and priorities effectively.
• Results-driven with strong organizational and time-management capabilities.

Benefits

• Comprehensive Medical, Dental & Vision benefits starting on the first of the month following hire date.
• 8 Paid Holidays per year.
• 2 Floating Holidays per year.
• Paid Time Off.
• 401(k).
• Wellness Program.
• Parental Leave.