Workers' Compensation Claims Specialist

biBerk Business Insurance

. Investigate coverage, determine compensability, and manage high-exposure Workers’ Compensation claims involving catastrophic injuries and complex cases .

Posted 10/23/2026full-timeRemote • United StatesSeniorLead💰 $95,000 - $115,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive experience in managing complex Workers’ Compensation claims, ensuring compliance with regulations, and providing exceptional customer service. Proficient in collaborating with various stakeholders and developing resolution strategies for high-exposure cases.

Highest-signal resume keywords

Active Adjuster License10+ Years Experience in Workers’ Compensation ClaimsKnowledge of Workers’ Compensation RegulationsExperience with Structured Settlements and Medicare Set-AsidesStrong Negotiation Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ManagementReserving and PricingSubrogation IdentificationLitigation ManagementComplex Loss ResolutionDocumentation of ClaimsMulti-State Claims HandlingAnalytical SkillsTime ManagementAttention to Detail

Soft Skills

Leadership SkillsCommunication SkillsOrganizational SkillsAbility to MultitaskAbility to Work Independently

Tools & Technologies

MS WordMS ExcelInternet Applications

Certifications & Qualifications

BA/BS DegreeAICSCLACPCU

Industry Keywords

Workers’ CompensationComplianceCatastrophic InjuriesMedical Treatment FacilitationEscalation and Reporting Requirements

About the role

Key responsibilities & impact

Investigate coverage, determine compensability, and manage high-exposure Workers’ Compensation claims involving catastrophic injuries and complex cases
Establish and update reserves throughout the life of claims and document supporting rationale
Resolve claims within authority and make independent case value recommendations to senior leadership when cases exceed authority
Participate in reserving, pricing, and strategy discussions with senior leadership
Collaborate with outside defense counsel to manage litigated files according to litigation management guidelines
Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and timely submission of medical bills
Ensure compliance with state and federal Workers’ Compensation regulations
Provide customer service to policyholders, agents, injured workers, medical providers, legal contacts, and vendors
Follow escalation and reporting requirements for claims with significant exposure
Develop resolution strategies for complex losses using internal and external resources
Document claim files according to company and regulatory guidelines
Identify subrogation potential and red flags requiring SIU involvement
Train new team members
Act as a technical resource to less experienced claims representatives
Report to the Workers’ Compensation Complex Claims Team Lead

Requirements

What you’ll need

Active adjuster license required
10+ years of experience handling complex workers’ compensation claims
Experience with structured settlements and Medicare Set-Asides
BA/BS degree required
AIC, SCLA, CPCU or other industry designation a plus
Knowledge of Workers’ Compensation regulations, laws, and best practices
Multi-state Workers’ Compensation claims experience in CT, DE, MI, NH, RI, VA, MA, PA, MN and WV preferred
Excellent organizational, leadership, communication, and time management skills
Ability to work in a fast-paced, collaborative, virtual office environment
Strong analytical, organizational, and time management skills
Excellent written and verbal communication skills
Ability to work independently and meet assigned deadlines
Strong negotiation skills
Ability to multitask and effectively prioritize tasks with frequent interruptions
Proficiency with MS Word, Excel, and internet applications
Highly attentive to details
Ability to work under pressure and exercise good judgment in sensitive situations
Advanced verbal and written communication skills for interacting with internal and external stakeholders
Ability to maintain continuing education requirements

Benefits

Comp & perks

Medical (PPO/HDHP), vision, disability, and life insurance
Enhanced dental plan with orthodontia coverage
Generous PTO plan
Paid company holidays and 4 floating holidays
Paid parental leave
Employee Retirement Savings Plan/401(k) with company match and immediate vesting
Education Assistance Program offering 100% upfront tuition reimbursement after 6 months of service for approved degree programs
Service Recognition Program with a monetary award toward a vacation every 5 years of employment
Wellness Initiatives including Fitness Center and Weight Watchers Reimbursement programs
Voluntary accident, critical illness, and hospital indemnity benefits
Employee discount and rewards program on travel, tickets, electronics, home, and more
Fully remote work arrangement
Occasional travel related to mediations, trainings, and department meetings