Claims Specialist II, Workers Compensation
Core
Investigate and resolve workers' compensation claims across multiple states, determining compensability, benefits, and managing case reserves.
Role type
Individual contributor claims specialist (workers' compensation)
Builds
Resolved claims and return-to-work initiatives for injured workers
Domain
Insurance / Workers' Compensation
Deliverable
client delivery
Required skills
Workers' compensation statutes, claims management, negotiation, medical terminology, litigation management, fraud investigation, Medicare reporting, third-party recovery
Preferred skills
Insurance theory, claims processing best practices, legal liability knowledge, claims systems proficiency, organizational skills
Technologies
Claims systems, electronic data interchange (EDI)
Responsibilities
Investigate claims and determine compensability and benefit rates; Manage case reserves and negotiate settlements; Pursue third-party recoveries and subrogation; Manage litigated claims and litigation budgets; Conduct customer visits and present educational workshops; Submit severe incident and Medicare reports.
Seniority
Mid-level, individual contributor
