Senior Workers' Compensation Claims Specialist

Distro
United States
Workplace: OnsiteFull timeUSD 48,000 - 69,000 annuallyFunction: People, HR & TalentExperience: 4-5 yearsEducation: bachelorsSkills: ["Analytical thinking","Critical thinking","Communication","Negotiation","Organizational skills"]

Manage multi-state workers’ compensation claims end-to-end, from inception through closure, with little supervision. Lead investigations, compensability analysis, medical review, reserve setting, and advanced exposure assessments to support fiscally sound settlement decisions. Serve as the primary client point of contact, providing expert guidance on risk mitigation, return-to-work strategies, and claim trends while coordinating with TPA adjusters, defense counsel, medical providers, and injured workers.

Loading

Loading job details...

Preparing the role view and application actions.

FursaFursa
Distro
Distro
3 days ago

Senior Workers' Compensation Claims Specialist

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 21 hours agoStatus: Live

Job Summary

Manage multi-state workers’ compensation claims end-to-end, from inception through closure, with little supervision. Lead investigations, compensability analysis, medical review, reserve setting, and advanced exposure assessments to support fiscally sound settlement decisions. Serve as the primary client point of contact, providing expert guidance on risk mitigation, return-to-work strategies, and claim trends while coordinating with TPA adjusters, defense counsel, medical providers, and injured workers.
Location: United States
Workplace: Onsite
Employment Type: Full time
Job Function: People, HR & Talent
Seniority: Mid level

Key Responsibilities

  • •Lead comprehensive investigations of complex workers' compensation claims, including coverage analysis, compensability determinations, medical review, and preparation of findings and recommendations for TPA adjusters.
  • •Evaluate TPA requests for reserve and settlement authority using exposure assessments based on prognosis, statutory benefits, vocational factors, litigation risk, and claim patterns.
  • •Advise clients on risk mitigation and proactive strategies by analyzing claim trends, identifying systemic issues, recommending safety improvements, and reducing workplace injuries and claim frequency.
  • •Serve as the main point of contact for client education, providing expert guidance to injured workers and supporting return-to-work program development and transitional work opportunities.
  • •Monitor and manage a portfolio of claims from filing through closure, coordinating with TPA adjusters, defense counsel, medical providers, and injured employees, while identifying delays or compliance issues and mentoring junior staff.
Travel: Low travel

Pay and Benefits

Salary: USD 48,000 - 69,000 annually
Perks:Health InsuranceDentalVision401kPaid LeaveParental LeaveLife InsuranceShort DisabilityLong DisabilityEmployee AssistanceFlexible SpendingIdentity TheftLegal InsurancePet Insurance

Key Requirements

  • •4-5 years of progressively responsible multi-state workers' compensation claims experience, ideally with a third-party administrator (TPA), insurance carrier, or employer risk management environment.
  • •Proven expertise managing complex, high-exposure, and litigated workers' compensation claims, including catastrophic injuries, long-term medical management, and settlement negotiations.
  • •Experience conducting in-depth investigations, evaluating compensability, analyzing medical documentation, and determining financial exposure.
  • •Strong background in return-to-work coordination, including developing light-duty programs and advising transitional work strategies.
  • •Advanced professional designations such as WCCA/WCCP, AIC, ARM, CWCP, or CPCU are desired.
Experience:4-5 yearsWorkers' compensation
Education:Bachelor's
Skills:Analytical thinkingCritical thinkingCommunicationNegotiationOrganizational skills
Certifications:WCCAWCCPAICARMCWCPCPCU
Tech Stack:ExcelMicrosoft OfficeOutlookMicrosoft TeamsWordPowerPoint

Company Brief

Distro
Provides a SaaS platform to simplify app distribution and release management, helping developers and teams build, share, and deploy mobile and web app builds to testers and stores.
Industry: Developer Tools
Website