Workers' Compensation Claims Representative

Role Overview

• Serve as the main liaison between insured clients and workers’ compensation insurance carriers.
• Facilitate timely communication regarding claim status, settlement decisions and action plans.
• Coordinate with adjusters, medical case managers, attorneys, agents, account manager and other involved parties to promote efficient claim resolution.
• Monitor open claims for assigned accounts to ensure proper handling, timely deadlines and compliance with applicable regulations.
• Review loss runs and document for accuracy and new claims; identify trends, anomalies, and opportunities for improvement.
• Advocate on behalf of insured clients to ensure appropriate medical management and expeditious claim resolution.
• Collaborate with clients to implement return-to-work programs and cost-containment strategies.
• Schedule and conduct Zoom, Teams, or telephonic meetings with carriers and other involved parties to advocate on behalf of insured clients and injured workers regarding claim status, legal issues, medical treatment concerns, and/or inefficiencies impacting timely resolution or closure of claims.
• Provide expert guidance to clients regarding workers’ compensation reporting, claim filing and documentation requirements.
• Assist clients with claim submissions and ensure all necessary information is provided to carriers.
• Participate in client claim review meetings, stewardship presentations, and renewal strategy sessions.
• Educate clients on workers’ compensation best practices, workplace safety, injury prevention and effective claims management.
• Provide workers’ compensation knowledge, insights, and recommendations to insured accounts not currently enrolled in the Claims Watch value-added service.

Requirements

• Associate’s or Bachelor’s degree in Business Administration, Risk Management, or a related field preferred.
• Minimum of 2–5 years of experience in workers’ compensation claims handling, carrier relations, or client advocacy within a brokerage, carrier, or TPA setting.
• Comprehensive understanding of state workers’ compensation statutes, medical case management practices, legal terminology and claims processes.
• Strong verbal and written communication skills with a client-service mindset, ability to resolve complaints and disputes.
• Proven ability to build and maintain effective professional relationships.
• Exceptional analytical, organizational, and problem-solving abilities.
• Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and claims management or CRM software.
• Ability to manage multiple priorities and deliver results in a fast-paced environment.
• Associate in Claims (AIC), Workers’ Compensation Claims Professional (WCCP), or similar industry designation preferred.
• State adjuster license or Self-Insurance Administrator (SIP) certificate (if required by jurisdiction).