Workers' Compensation Specialist

Summary:

The Workers’ Compensation Specialist is responsible for managing the end-to-end workers’ compensation claims process, ensuring timely, accurate, and cost-effective resolution of all claims. This role serves as the primary liaison between the organization, Third-Party Administrator (TPA), insurance carriers, and internal stakeholders to monitor claim progression, control claim costs, and ensure compliance with all regulatory requirements.

This position also plays a critical employee-facing role, providing outreach and support to injured team members, ensuring appropriate care, clear communication, and timely return-to-work whenever possible. The Workers’ Compensation Specialist uses data, analytics, and proactive claim management to reduce financial exposure while supporting employee well-being.

Essential Functions & Responsibilities:

Claims Management & Administration

• Serve as the primary point of contact with the Third-Party Administrator (TPA) for all workers’ compensation claims.
• Manage the full life cycle of each claim, from incident reporting through closure.
• Ensure timely and accurate submission of all required documentation.
• Monitor claim activity, medical treatment, indemnity payments, and return-to-work status.
• Proactively identify claims requiring escalation, intervention, or additional medical or legal review.

Cost Control & Risk Mitigation

• Actively manage reserves, settlements, and claim strategies to minimize financial exposure.
• Review and challenge inappropriate claim charges, treatment plans, or reserve levels with the TPA.
• Identify opportunities for early return-to-work, light duty, or modified assignments.
• Support litigation management and coordinate with legal counsel as needed.

Employee Outreach & Support

• Contact injured team members promptly following claim submission to ensure proper care and explain next steps.
• Maintain ongoing communication throughout the claim to support recovery and engagement.
• Serve as a trusted resource regarding benefits, medical treatment, and return-to-work expectations.
• Partner with HR and Operations to support smooth reintegration following injury.

Reporting, Analytics & Compliance

• Track and report on key claim metrics including claim counts, reserves, medical and indemnity costs, and trends.
• Prepare dashboards and reports for HR, Safety, Finance, and leadership.
• Analyze claims data to identify patterns, risk drivers, and prevention opportunities.
• Ensure compliance with federal, state, and insurance reporting requirements.

Collaboration & Process Improvement

• Partner with Safety, HR, and Operations to improve injury prevention and reporting accuracy.
• Participate in incident reviews and root-cause analysis.
• Support training and awareness initiatives related to workers’ compensation procedures.
• Recommend and implement process improvements to strengthen claim handling and cost control.

Special Projects

• Support insurance renewals, audits, and claim reviews.
• Participate in system upgrades and reporting enhancements.
• Perform other related duties as assigned.

Required Qualifications:

Education

• Bachelor’s degree in Human Resources, Business Administration, Risk Management, or related field preferred.

Experience

• Minimum 3–5 years of workers’ compensation, claims management, or risk management experience.
• Experience working with TPAs, insurance carriers, and medical providers.
• Strong knowledge of workers’ compensation laws, claim life cycles, and cost-containment strategies.

Skills & Competencies:

• Strong analytical and organizational skills with high attention to detail.
• Excellent interpersonal and communication skills.
• Ability to support injured employees with empathy while maintaining firm claim oversight.
• Discretion in handling sensitive and confidential information.
• Strong problem-solving skills and ability to manage multiple priorities.

Technical Skills:

• Proficient in Microsoft Office 365 (Excel, Word, Outlook).
• Experience with claims management and reporting systems preferred.

Core Competencies:

• Claims & Risk Management
• Problem Solving / Analysis
• Communication & Employee Advocacy
• Financial Acumen
• Compliance Orientation
• Collaboration
• Organization & Time Management

Compensation & Benefits:

• Comprehensive benefits package including:
• Medical, dental, and vision
• 401(k) with company match
• Generous PTO and paid holidays.