Workers' Compensation Claims Representative (Midwest)

Accountabilities: Manage workers' compensation claims: Oversee a caseload of lost-time claims across multiple jurisdictions, ensuring timely, accurate, and consistent handling throughout the claims lifecycle. Evaluate compensability and coverage: Analyze claim circumstances, policy coverage, medical records, and factual evidence to determine eligibility and identify potential coverage issues. Investigate claims: Gather and assess medical documentation, incident reports, and other relevant evidence to support informed decisions and appropriate claim resolutions. Negotiate settlements: Develop settlement strategies, negotiate claim resolutions, and direct settlements within delegated authority and subject to management review. Manage litigation: Coordinate litigated claims, work with legal representatives, and oversee outside investigations in accordance with established authority and procedures. Coordinate with stakeholders: Maintain regular communication with claimants, their attorneys, insured businesses, account liaisons, medical providers, outside investigators, and rehabilitation professionals. Resolve complex cases: Apply analytical judgment, problem-solving skills, and conflict-resolution techniques to address disputes, manage claim risks, and support appropriate outcomes. Maintain claim documentation: Keep accurate and complete claim records, document decisions, and ensure files are managed in accordance with applicable requirements and internal procedures. Requirements Education and experience: A bachelor's degree and at least 3 years of relevant workers' compensation claims experience, or a bachelor's degree with at least 5 years of relevant claims experience if the degree requirement is not met. Required certification: A Claims Adjuster Designation or SIP certification is required. Texas claims experience: Demonstrated experience adjusting workers' compensation claims in Texas is mandatory. Multi-jurisdictional expertise: Experience handling claims across multiple jurisdictions is valuable, with experience in Oklahoma and Alaska preferred. Claims handling background: Experience managing lost-time and/or litigated workers' compensation claims is required; insurance carrier experience is preferred. Medical knowledge: Familiarity with medical terminology and the ability to interpret medical documentation when evaluating workplace injuries and claim compensability. Negotiation and conflict resolution: Strong negotiation, decision-making, and dispute-resolution skills, with the ability to manage sensitive situations and achieve appropriate claim outcomes. Analytical and organizational skills: Excellent attention to detail, sound judgment, strong organizational abilities, and the capacity to manage a demanding caseload effectively. Communication skills: Excellent written and verbal communication skills, with the ability to interact professionally with claimants, attorneys, medical providers, and other stakeholders. Independent work style: Ability to work autonomously in a fully remote setting, prioritize competing demands, and maintain consistent productivity and service quality. Benefits Competitive annual salary: $75,000–$92,000, depending on qualifications, geographic location, and other applicable factors. Fully remote work: Work from anywhere in the continental United States. Medical coverage: Medical insurance options, including PPO and high-deductible health plans. Dental and vision insurance: Comprehensive dental coverage, including an enhanced plan with orthodontia benefits, plus vision insurance. Financial protection: Disability and life insurance, along with voluntary accident, critical illness, and hospital indemnity coverage. Retirement savings: 401(k) plan with an employer match and immediate vesting. Paid time off: Generous PTO for eligible employees, paid company holidays, and four floating holidays. Paid parental leave: Support for employees welcoming a child. Education assistance: Eligible employees can receive 100% upfront tuition reimbursement for approved degree programs after six months of service. Wellness programs: Fitness center and Weight Watchers reimbursement initiatives. Employee recognition: A service recognition program offering a monetary award toward a vacation every five years of employment. Employee discounts: Access to savings and rewards on travel, tickets, electronics, home products, and more. No bonus potential: This position does not include eligibility for a performance bonus.