This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Workers' Compensation Claims Representative (Midwest) based in the United States. Overview We are seeking an experienced Workers' Compensation Claims Representative to manage lost-time claims across multiple jurisdictions in a fully remote environment. In this role, you will evaluate claim compensability, investigate workplace injuries, assess medical and factual evidence, and determine appropriate claim outcomes. You will oversee claims from initial evaluation through resolution, including settlement negotiations and litigation management. Working closely with claimants, attorneys, medical providers, investigators, and insured businesses, you will help ensure claims are handled accurately, fairly, and efficiently. Your expertise in workers' compensation regulations, particularly in Texas, will be essential to managing complex cases and resolving disputes. This opportunity is ideal for a detail-oriented claims professional who combines sound judgment, strong negotiation skills, and a commitment to delivering high-quality service. 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.
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