Claims Specialist-WC
Core
Administers and resolves non-complex short-term workers' compensation claims, including medical-only and lost-time disability claims up to $2,500.
Role type
Claims Specialist (Workers' Compensation)
Builds
Resolves individual insurance claims for injured workers
Domain
Insurance / Workers' Compensation
Required skills
claim processing, liability determination, reserve establishment, medical bill coding, fraud detection, policy verification, wage loss calculation, state regulations compliance
Preferred skills
Associate in Claim designation, specialized claims courses
Technologies
medical bill coding rules, state regulations
Responsibilities
Conduct investigations to confirm coverage and determine liability; verify policy coverage and establish reserves; identify wage loss expenses; evaluate medical claims for fraud; approve payments within authority limits; document case inventory and close files; interact with claimants and medical professionals; complete reporting forms and file documentation.
Seniority
Individual Contributor, entry to mid-level