SUMMARY

The Workers Compensation Specialist is responsible for managing the end-to-end workers’ compensation claims process, ensuring timely, accurate, and cost-effective resolution of all claims. This role serves as the primary liaison between the company, Third Party Administrator (TPA), insurance carriers, and internal stakeholders to monitor claim progression, control claim costs, and ensure compliance with all regulatory requirements.

This position also plays a critical employee-facing role, providing outreach and support to injured team members, ensuring appropriate care, clear communication, and timely return-to-work whenever possible. The Workers Compensation Specialist uses data, analytics, and proactive claim management to reduce financial exposure while supporting employee well-being.

ESSENTIAL FUNCTIONS, RESPONSIBILITIES AND DUTIES:

Claims Management & Administration

• Serve as the primary point of contact with the Third-Party Administrator (TPA) for all workers’ compensation claims.
• Manage the full life cycle of each claim, from incident reporting through closure.
• Ensure timely and accurate submission of all required claim documentation.
• Monitor claim activity, medical treatment, indemnity payments, and return-to-work status.
• Proactively identify claims that require escalation, intervention, or additional medical or legal review.

Cost Control & Risk Mitigation

• Actively manage reserves, settlements, and claim strategies to minimize financial exposure to the company.
• Review and challenge inappropriate claim charges, treatment plans, or reserve levels with the TPA.
• Identify opportunities for early return-to-work, light duty, or modified assignments.
• Support litigation management and coordinate with legal counsel as required.

Employee Outreach & Support

• Contact injured team members promptly following claim submission to express concern, explain the process, and ensure proper care is being provided.
• Maintain ongoing communication with employees throughout the claim to support recovery and reinforce engagement.
• Serve as a trusted resource to answer questions about benefits, medical treatment, and return-to-work expectations.
• Partner with HR and Operations to ensure smooth reintegration of employees returning from injury.

Reporting, Analytics & Compliance

• Track and report on claim metrics including new claims, closed claims, open claims, reserves, medical and indemnity costs, and trends.
• Prepare regular dashboards and reports for HR, Safety, Finance, and executive leadership.
• Monitor claims data to identify patterns, risk drivers, and opportunities for loss prevention.
• Ensure compliance with federal, state, and insurance reporting requirements.

Collaboration & Process Improvement

• Partner with Safety, HR, Operations, to improve injury prevention, reporting accuracy, and claim outcomes.
• Participate in incident reviews and root-cause analysis to reduce future claims.
• Support training and awareness initiatives related to injury reporting and workers’ compensation procedures.
• Recommend and implement process improvements to strengthen claim handling and cost control.

Special Projects

• Adapt to evolving organizational priorities by taking on special assignments and interim responsibilities as requested.
• Support insurance renewals, audits, and claims reviews.
• Participate in system upgrades or reporting enhancements related to workers’ compensation and risk management.
• Perform other related duties as assigned.

This role offers a salary range of $100,000– $125,000 annually, based on skills, experience, and location. Employees also receive a comprehensive benefits package including health, dental, vision, 401(k) with company match, generous PTO, and paid holidays.

Requirements

REQUIRED QUALIFICATIONS:

Education

• Bachelor’s degree in human resources, Business Administration, Risk Management, or a related field preferred.

EXPERIENCE, OTHER QUALIFICATIONS AND COMPETENCIES

Experience

• Minimum of 3–5 years of workers’ compensation, claims management, or risk management experience.
• Experience working directly with TPAs, insurance carriers, and medical providers.
• Strong understanding of workers’ compensation laws, claim life cycles, and cost-containment strategies.

Other Qualifications

• Strong analytical and organizational skills with high attention to detail.
• Excellent interpersonal skills with the ability to communicate compassionately with injured employees while maintaining firm claim oversight.
• Ability to manage sensitive, confidential information with professionalism and discretion.
• Strong problem-solving skills and ability to manage multiple claims and deadlines.
• Bi-Lingual: Spanish

Computer Skills

• Proficient in Microsoft Office 365 (Excel, Word, Outlook).
• Experience with claims management systems and reporting platforms preferred.

Required Competencies

• Claims & Risk Management
• Problem Solving / Analysis
• Communication Skills
• Attention to Detail
• Employee Advocacy & Customer Service
• Financial Acumen
• Compliance Orientation
• Collaboration
• Organization & Time Management

Expected Hours of Work:

This is a full-time exempt position. Typical work hours are Monday - Friday, 8:00am - 5:00 pm with additional hours needed to meet business demands and production schedules. As an exempt position, it is expected that Team Member will devote whatever time necessary to accomplish the goals and responsibilities. This will often require extended work hours, evening, and/or weekend work.