FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing complex workers’ compensation claims, including advanced investigations, medical case management, and strategic negotiations. Proficient in regulatory compliance, benefit calculations, and mentoring claims adjusters.
Highest-signal resume keywords
Workers’ Compensation Claims ManagementAdvanced InvestigationsMedical Case ManagementNegotiation of Complex SettlementsRegulatory Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims HandlingCoverage InvestigationFraud InvestigationSubrogation AnalysisBenefit CalculationReturn-to-Work Strategy DevelopmentMedical Bill ReviewNegotiation SkillsStrategic ReportingData Integrity Maintenance
Soft Skills
MentoringCoachingCustomer Service ResolutionCross-Departmental CollaborationWorkflow Improvement Participation
Certifications & Qualifications
Associate in Claims (AIC)AIMCPCUTexas All-Lines License
Industry Keywords
Workers’ CompensationMedicare ComplianceCMS EngagementStructured SettlementsRisk Management
About the role
Key responsibilities & impact- Manage highly complex workers’ compensation claims involving significant financial exposure, legal intricacies, and extended life cycles
- Conduct advanced investigations into coverage, compensability, fraud, and loss prevention
- Oversee medical case management for catastrophic injuries and lifetime care needs
- Review and authorize large or complex medical bills and negotiate adjustments to control costs
- Develop return-to-work strategies with policyholders, legal counsel, and vocational consultants
- Ensure accurate benefit calculations for high-exposure claims
- Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery
- Partner with legal teams on complex settlements and litigation processes
- Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement
- Identify structured-settlement opportunities and lead negotiations
- Produce strategic reports on high-profile claims and prepare claims for Corporate Plan of Action meetings
- Lead cross-departmental claims-handling and risk-management improvements
- Resolve escalated customer service issues and support high-value accounts
- Participate in workflow improvement initiatives and committees
- Mentor and coach junior and intermediate adjusters
- Review escalated claims and provide actionable feedback
- Support workforce development and succession planning
Requirements
What you’ll need- 7–10 years of claims handling experience, with high exposure to Workers’ Compensation
- Bachelor’s degree in business or related field preferred, or equivalent industry experience
- Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain
- Texas All-Lines license preferred
- Valid driver’s license required
- Ability to manage highly complex, high-exposure workers’ compensation claims
- Experience conducting advanced coverage, compensability, fraud, subrogation, and loss-prevention investigations
- Knowledge of nuanced statutory interpretations and regulatory compliance
- Experience overseeing medical case management for catastrophic injuries and lifetime care needs
- Experience reviewing and authorizing large or complex medical bills and negotiating adjustments
- Experience developing return-to-work strategies and calculating benefits while addressing tax and compliance risks
- Experience negotiating complex settlements, managing litigation processes, Medicare Set-Asides, and CMS engagement
- Ability to produce strategic claims reports and maintain system data integrity
- Ability to mentor and coach junior and intermediate adjusters
Benefits
Comp & perks- Medical, dental, and vision health plans, including fertility benefits, fully paid preventive care, and adult orthodontia
- Employer-paid life insurance equal to 3x base salary
- Employer-paid AD&D insurance
- Employer-paid short- and long-term disability
- Employer-paid wellness and recognition incentives for employees and spouses
- Flexible Spending Account and dependent care options
- Health Savings Account with generous employer contribution
- Generous paid time off
- 11 holidays and 4 early releases
- 16 hours volunteer time off
- 20 days paid parental leave
- Marriage, bereavement, and jury duty leave
- Employee Assistance Programs
- 401(k) retirement plan with employer match and profit sharing
- Adoption assistance
- Tuition assistance