Workers' Compensation Claims Specialist – Complex

biBerk Business Insurance

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

Posted 10/27/2026full-timeRemote • United StatesSeniorLead💰 $100,000 - $125,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise 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 ClaimsMulti-State Claims ExperienceComprehensive Knowledge of Workers’ Compensation RegulationsStrong Analytical and Organizational Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Complex Claims ManagementReserving and Pricing StrategiesSubrogation IdentificationStructured SettlementsMedicare Set-Asides

Soft Skills

LeadershipCommunicationNegotiationTime ManagementAttention to Detail

Tools & Technologies

MS WordMS ExcelInternet Applications

Certifications & Qualifications

AICSCLACPCUActive Adjuster LicenseSIP

Industry Keywords

Workers’ CompensationLitigation ManagementComplianceCustomer ServiceFast-Paced Environment

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 each claim and document supporting rationale
Resolve claims within authority and make independent case value recommendations to senior leadership for cases exceeding 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 medical-bill submission
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 and serve 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 or SIP
10+ years of experience handling complex workers’ compensation claims
Multi-state Workers’ Compensation claims experience; California, Arizona, and Colorado jurisdiction experience preferred
Comprehensive knowledge of Workers’ Compensation regulations, laws, and best practices
Experience with structured settlements and Medicare Set-Asides
BA/BS degree required
AIC, SCLA, CPCU, or other industry designation a plus
Strong analytical, organizational, leadership, communication, negotiation, and time-management skills
Ability to work independently, meet deadlines, multitask, prioritize tasks, and work under pressure
Ability to work in a fast-paced, collaborative, virtual office environment
Proficiency with MS Word, Excel, and internet applications
High attention to detail and sound judgment in sensitive situations
Advanced verbal and written communication skills for 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 to attend mediations, trainings, and/or department meetings