Workers' Compensation Claims Representative (Midwest)

Accountabilities

Manage workers' compensation claims: Oversee a caseload of lost-time claims across multiple jurisdictions, ensuring timely, accurate, and consistent handling throughout the claims lifecycle.
Evaluate compensability and coverage: Analyze claim circumstances, policy coverage, medical records, and factual evidence to determine eligibility and identify potential coverage issues.
Investigate claims: Gather and assess medical documentation, incident reports, and other relevant evidence to support informed decisions and appropriate claim resolutions.
Negotiate settlements: Develop settlement strategies, negotiate claim resolutions, and direct settlements within delegated authority and subject to management review.
Manage litigation: Coordinate litigated claims, work with legal representatives, and oversee outside investigations in accordance with established authority and procedures.
Coordinate with stakeholders: Maintain regular communication with claimants, their attorneys, insured businesses, account liaisons, medical providers, outside investigators, and rehabilitation professionals.
Resolve complex cases: Apply analytical judgment, problem-solving skills, and conflict-resolution techniques to address disputes, manage claim risks, and support appropriate outcomes.
Maintain claim documentation: Keep accurate and complete claim records, document decisions, and ensure files are managed in accordance with applicable requirements and internal procedures.
Requirements
Education and experience: A bachelor's degree and at least 3 years of relevant workers' compensation claims experience, or a bachelor's degree with at least 5 years of relevant claims experience if the degree requirement is not met.
Required certification: A Claims Adjuster Designation or SIP certification is required.
Texas claims experience: Demonstrated experience adjusting workers' compensation claims in Texas is mandatory.
Multi-jurisdictional expertise: Experience handling claims across multiple jurisdictions is valuable, with experience in Oklahoma and Alaska preferred.
Claims handling background: Experience managing lost-time and/or litigated workers' compensation claims is required; insurance carrier experience is preferred.
Medical knowledge: Familiarity with medical terminology and the ability to interpret medical documentation when evaluating workplace injuries and claim compensability.
Negotiation and conflict resolution: Strong negotiation, decision-making, and dispute-resolution skills, with the ability to manage sensitive situations and achieve appropriate claim outcomes.
Analytical and organizational skills: Excellent attention to detail, sound judgment, strong organizational abilities, and the capacity to manage a demanding caseload effectively.
Communication skills: Excellent written and verbal communication skills, with the ability to interact professionally with claimants, attorneys, medical providers, and other stakeholders.
Independent work style: Ability to work autonomously in a fully remote setting, prioritize competing demands, and maintain consistent productivity and service quality.
Benefits
Competitive annual salary: $75,000–$92,000, depending on qualifications, geographic location, and other applicable factors.
Fully remote work: Work from anywhere in the continental United States.
Medical coverage: Medical insurance options, including PPO and high-deductible health plans.
Dental and vision insurance: Comprehensive dental coverage, including an enhanced plan with orthodontia benefits, plus vision insurance.
Financial protection: Disability and life insurance, along with voluntary accident, critical illness, and hospital indemnity coverage.
Retirement savings: 401(k) plan with an employer match and immediate vesting.
Paid time off: Generous PTO for eligible employees, paid company holidays, and four floating holidays.
Paid parental leave: Support for employees welcoming a child.
Education assistance: Eligible employees can receive 100% upfront tuition reimbursement for approved degree programs after six months of service.
Wellness programs: Fitness center and Weight Watchers reimbursement initiatives.
Employee recognition: A service recognition program offering a monetary award toward a vacation every five years of employment.
Employee discounts: Access to savings and rewards on travel, tickets, electronics, home products, and more.
No bonus potential: This position does not include eligibility for a performance bonus.