Senior Claims Representative – Workers' Compensation

Pacific Neuroscience Institute (PNI)

. Investigate, evaluate, and dispose of assigned workers’ compensation claims in a timely manner .

Posted 10/16/2026full-timeUnited StatesSenior💰 $75,000 - $103,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive experience in workers' compensation claims handling, including negotiation, documentation, and compliance with legal statutes. Proficient in developing case strategies and collaborating with various stakeholders to achieve optimal settlements.

Highest-signal resume keywords

Workers' Compensation Claims HandlingNegotiation SkillsClaims DocumentationAdjuster's LicenseUnderstanding of Tort and State Laws

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims InvestigationSubrogation and SalvageClaims File DevelopmentCoverage VerificationClaims Analysis

Soft Skills

Communication SkillsCustomer ServiceDecision-MakingPlanning and OrganizationTeam Collaboration

Tools & Technologies

Microsoft Office ProductsAutomated Claims Systems

Certifications & Qualifications

IIA Certificate in General InsuranceSenior Claims Law AssociateAssociate in ClaimsWorkers’ Compensation Courses (PA 10, 11, 12, 13)

Industry Keywords

Unfair Claims Settlement ActInsurance Policy CoveragesMedical TerminologyLegal TerminologyAutomotive TerminologyConstruction Terminology

About the role

Key responsibilities & impact

Investigate, evaluate, and dispose of assigned workers’ compensation claims in a timely manner
Achieve best-practices settlements within legal statutes, policy provisions, and company/client guidelines
Initiate self-development and training to improve, maintain, or acquire claims-handling skills
Identify and pursue subrogation, contribution, and salvage opportunities
Communicate tactfully and completely to support negotiations, rapport, and a positive corporate image
Handle claims involving complex coverage and liability issues
Attend civil proceedings or workers’ compensation hearings as needed
Develop claims files from initial assignment through disposition
Prepare accurate and complete claim-file documentation and audit trails
Participate in Claims Catastrophe Teams and potentially supervise a Claims Catastrophe Team
Verify coverages, set or adjust reserves, and make appropriate contacts
Collaborate with Team Leaders, Managers, Home Office, branch underwriting, claims service office personnel, agents, insureds, claimants, medical and legal professionals, appraisers, and independent adjusters
Develop case strategy, advance investigations, and dispose of claims
Perform other duties assigned by reporting managers

Requirements

What you’ll need

Minimum of 5 years of experience in workers' compensation claims handling
Continuing education in insurance-related courses preferred, such as IIA Certificate in General Insurance, Senior Claims Law Associate, Associate in Claims, and Workers’ Compensation courses (PA 10, 11, 12, and 13)
Associate's degree in Claims and/or Senior Claims Law Associate designations preferred
Adjuster's license or willingness to obtain one as required
Good understanding of tort and state laws applicable to assigned claims
Good understanding of the Unfair Claims Settlement Act and insurance policy coverages and provisions
Good understanding of medical, legal, automotive, and construction terminology applicable to assigned claims
Good oral and written communication skills
Good negotiation, customer service, analysis, evaluation, decision-making, planning, and organization skills
Strong sense of urgency
Good PC skills, with emphasis on Microsoft Office Products
Ability to work independently and as part of a team
Ability to see and effectively use a computer monitor
Ability to operate a computer, keyboard, applicable printers, and general office equipment
Ability to access and enter information accurately using automated systems
Ability to hear and communicate via telephone and/or monitoring devices
Ability to present information to individuals and groups
Ability to interpret and apply concepts that may or may not be based upon established guidelines
Acceptable attendance and adherence to scheduled work hours
Valid driver’s license and ability to operate a motor vehicle
Ability to travel, with overnight stays required

Benefits

Comp & perks

Annual incentive program, subject to eligibility
Generous 401(k) match
Graded profit sharing
Incentive compensation
Health and other benefits supporting financial health, physical well-being and career development
Remote and hybrid work options
Flexible scheduling
“Dress-for-your-day” culture
Employee recognition programs
Community engagement and charitable efforts
Employee volunteering opportunities
United Way campaign with employee contributions and company matches
Continuing education support
100% tuition reimbursement for academic studies
Professional development and designation programs, including CPCU, AINS, CPA, CISSP, and more
Long-term career growth and development opportunities