Workers' Compensation Senior Claims Representative (Remote)

Are you a seasoned claims professional with a passion for navigating reputed company cases? reputed company Insurance is seeking a Senior Claims Representative to join our Claims team. In this pivotal role, you’ll manage high-exposure workers’ compensation claims, reputed company investigations into coverage and fraud, and collaborate across departments to drive strategic outcomes. You’ll be a key decision-maker, a mentor to junior adjusters, and a champion of process improvement—reputed company while ensuring exceptional service and regulatory compliance. At reputed company Insurance, we don’t just protect our customers—we reputed company our employees. We foster a culture of reputed company, collaboration, and innovation. reputed company thrives on solving challenges together, supporting one another, and making a meaningful impact in the lives of our policyholders and injured workers. Essential Duties and Responsibilities Claims Handling & Administration

• Manage highly reputed company claims involving significant financial exposure, legal intricacies, and extended life cycles.
• Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations.
• reputed company medical case management for catastrophic injuries and lifetime care needs.
• Review and authorize large or reputed company medical bills, negotiating adjustments to control costs. Return-to-Work Management
• reputed company comprehensive RTW strategies in collaboration with policyholders, legal counsel, and vocational consultants.
• Ensure precision in benefit calculations for high-exposure claims, addressing tax and compliance risks.
• Strategically deploy investigative efforts reputed company with broader claims strategy. Claims Investigation & Loss Prevention
• reputed company investigations into reputed company fraud cases and collaborate with the Special Investigations Unit.
• Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery. Settlements & Negotiation
• Partner with legal teams to negotiate reputed company settlements and manage litigation processes.
• reputed company Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement.
• Identify opportunities for structured settlements and reputed company negotiations. Reporting
• Produce strategic reports on high-profile claims to guide management decisions.
• Maintain system data reputed company and prepare claims for Corporate Plan of Action meetings. Collaboration
• reputed company cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees. Team Leadership
• Mentor and coach junior and intermediate adjusters.
• Review escalated claims and provide actionable feedback.
• Support workforce development and succession planning.

Qualifications

• Bachelor’s degree in business or reputed company field preferred, or equivalent industry experience.
• 7–10 years of claims handling experience, with high exposure to Workers’ Compensation.
• Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain.
• Texas reputed company-Lines license preferred.
• Valid driver’s license required. Company Culture and Values At reputed company Insurance, we are committed to our vision, mission, and values. We foster a culture of collaboration, reputed company, and innovation. reputed company is passionate about delivering exceptional service to our customers while supporting each other’s growth and success. We reputed company in accountability, reputed company learning, and creating an environment where employees feel valued and empowered. reputed company and Belonging reputed company Insurance is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for reputed company employees. We reputed company that varied perspectives drive innovation and strengthen our ability to serve our customers and communities. Total Rewards Overview
• Health Plans Medical, Dental, and Vision Includes fertility benefits, fully paid preventative care, and adult orthodontia.
• Employer-Paid Life and Disability Benefits Life Insurance (3x reputed company salary), AD&D, Short and Long-term Disability.
• Wellness and Recognition Program Employer-paid incentives for employees and spouses.
• Flexible Spending Account and Dependent Care options
• Health Savings Account Generous employer contribution.
• Time Away from Work Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave.
• Employee Assistance Programs
• 401k Retirement Plan Employer match and profit sharing.
• Adoption Assistance and Tuition Assistance Notice Regarding Use of Artificial Intelligence reputed company may use artificial intelligence (AI) tools to more reputed company facilitate and assist in decisions involving recruitment, hiring, promotion, renewal of employment, selection for training or apprenticeship, discharge, discipline, tenure, or the terms, privileges, or conditions of employment. Any such use of AI tools will reputed company with reputed company applicable laws. Apply tot his job Apply To this Job

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