workers compensation claims analyst

Acrisure LLC

<p></p><div><h2 class="jobSectionHeader"><b>Job Description</b></h2><p><b>
About Acrisure</b><br>
A global fintech leader, Acrisure empowers millions of ambitious businesses and individuals with the right solutions to grow boldly forward. Bringing cutting-edge technology and top-tier human support together, we connect clients with customized solutions across a range of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more.</p><p></p><p>
In the last twelve years, Acrisure has grown in revenue from $38 million to almost $5 billion and employs over 19,000 colleagues in more than 20 countries. Acrisure was built on entrepreneurial spirit. Prioritizing leadership, accountability, and collaboration, we equip our teams to work at the highest levels possible.</p><p></p><p><b>
JOB SUMMARY</b></p><p>
Acrisure is seeking a Claims Analyst II to manage multi-state workers&rsquo; compensation claims, including indemnity, employer&rsquo;s liability, and subrogation exposures. This role is responsible for independently handling claims from assignment through resolution, ensuring timely, accurate, and compliant claim outcomes.</p><p></p><p>
The Claims Analyst II will evaluate coverage, determine compensability, manage litigation, and coordinate all aspects of the claims process. This position is well suited for an experienced claims professional who is comfortable working in a fast paced environment and managing multiple files with a high level of autonomy.</p><p><b>
Responsibilities</b></p><ul><li>
Manage a caseload of multi-state workers&rsquo; compensation claims, including indemnity, employer&rsquo;s liability, and subrogation exposures</li><li>
Conduct initial claim investigation, including coverage verification, compensability determination, and timely contact with involved parties</li><li>
Communicate with injured workers, employers, medical providers, attorneys, and other stakeholders to support claim resolution</li><li>
Set and manage reserves to ultimate probable cost within established authority levels</li><li>
Ensure timely delivery of benefits and required notices in accordance with jurisdictional requirements</li><li>
Coordinate return to work efforts in alignment with medical guidance and employer programs</li><li>
Manage litigation, including directing defense counsel and attending hearings or depositions as needed</li><li>
Negotiate settlements with injured workers, attorneys, and other parties</li><li>
Identify and pursue subrogation opportunities and manage third party recoveries</li><li>
Review medical and expense bills for accuracy, causation, and appropriateness</li><li>
Maintain accurate and timely documentation within the claims system</li><li>
Prepare claim status reports and participate in claim review meetings</li><li>
Assign and coordinate nurse case management resources when appropriate</li><li>
Collaborate with leadership on complex claims requiring additional support or escalation</li></ul><p><b>
Requirements</b></p><ul><li>
Experience handling workers&rsquo; compensation claims required</li><li>
2 to 5 years of relevant claims experience or equivalent experience required</li><li>
Strong understanding of workers&rsquo; compensation laws, claims processes, and jurisdictional requirements</li><li>
Experience managing indemnity claims, litigation, and claim resolution strategies</li><li>
Strong analytical skills, decision making ability, and attention to detail</li><li>
Strong communication and negotiation skills</li><li>
Ability to manage multiple claims in a fast paced environment</li><li>
Strong organizational and time management skills</li><li>
Proficiency with Microsoft Office and claims management systems</li><li>
Ability to work independently with limited supervision</li><li>
Litigation experience beneficial</li></ul><p><b>
Education and Licenses</b></p><ul><li>
High school diploma required, bachelor&rsquo;s degree beneficial</li><li>
Relevant state licensing beneficial or ability to obtain as required</li></ul><p></p><p>
Pay Details:</p><p></p>
The base compensation range for this position is $60,000 - $71,050. This range reflects Acrisure's good faith estimate at the time of this posting. Placement within the range will be based on a variety of factors, including but not limited to skills, experience, qualifications, location, and internal equity.<p></p><p><b>
Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.</b></p><p></p><p><b><br>
Why Join Us:</b></p><p>
At Acrisure, we&rsquo;re building more than a business, we&rsquo;re building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future.</p><p></p><p>
Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York.</p><p></p><p><b><br>
Employee Benefits</b></p><p>
We also offer our employees a comprehensive suite of benefits and perks, including:</p><ul><li><p><b>
Physical Wellness:</b> Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.</p></li><li><p><b>
Mental Wellness:</b> Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.</p></li><li><p><b>
Financial Wellness:</b> Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.</p></li><li><p><b>
Family Care:</b> Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.</p></li><li><p><b>
&hellip; and so much more!</b></p></li></ul><p><i>
This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.</i></p><p></p><p><b><br>
Acrisure is an Equal Opportunity Employer.</b> We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting <i>leaves@acrisure.com</i>.</p><p></p><p>
Final candidates will be required to complete post-offer verification processes related to the role and in accordance with applicable laws.</p><p></p><p><b><br>
California Residents:</b> Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy.</p><p></p><p><b><br>
Recruitment Fraud: </b>Please visit here to learn more about our Recruitment Fraud Notice.</p><p></p><p><b><br>
Welcome, your new opportunity awaits you.</b></p></div>

Claims Analyst II

Berkley

<div>Company Details:
<div></div><div>
Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker&rsquo;s successful and speedy return to work is good for people and good for Berkley&rsquo;s insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology as a way to deliver the best outcome for injured workers and Berkley&rsquo;s operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers&rsquo; compensation cases.</div><div></div><div><br>
To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkley&rsquo;s operating units with reliable results, and reduced time and expenses associated with case management.</div><br>
<div></div>
Responsibilities:
<div>
The position serves as a subject-matter expert for Medical Bill Review (MBR) operations, providing advanced production support, driving process improvements, and coordinating cross-functional issue resolution and project execution. As an Operations Analyst, you will support the processing of workers&rsquo; compensation medical and pharmacy bills from bill intake through bill payment and is a primary resource for issue resolution related to these processes. You will work directly with Berkley Operating Units to investigate bill processing issues and are responsible for problem-solving, identifying and triaging issues to technical teams, directly interfacing with multiple vendors to facilitate issue resolution, issue documentation, tracking, and reporting. You may also work directly with medical providers and networks regarding billing issues. We&rsquo;ll also look to you to independently and as part of a team identify issue commonalities and root causes to assist in solution design, monitoring, and controlling.</div><div><br>
</div><div>The position serves as a subject-matter expert for Medical Bill Review (MBR) operations, providing advanced production support, driving process improvements, and coordinating cross-functional issue resolution and project execution. Core responsibilities include:</div><div><b>
MBR Production Support &amp; Issue Resolution</b></div><ul><li>
Serve as the primary escalation point for complex MBR issues that cannot be resolved by Operations Technician/Level 1 support, vendors, or related internal teams (Clinical Validation, Negotiations, OU adjusters, mailroom).</li><li>
Diagnose operational and adjudication issues by applying deep MBR process knowledge and collaborating with vendors and internal partners to resolve root causes.</li><li>
Provide backup Level 1 support, including bill-level troubleshooting, Jira ticket creation/maintenance, report distribution, and vendor communications.</li><li>
Maintain timely, clear communication with Operating Units, providers, and stakeholders regarding issue status, outcomes, and required actions.</li></ul><div><b>
Operational Analysis, Monitoring &amp; Continuous Improvement</b></div><ul><li>
Monitor business dashboards and vendor reports daily to identify and escalate adverse bill TAT trends, identify likely root cause owners, and track resolution progress.</li><li>
Recommend workflow enhancements, rule updates, and process changes to improve MBR accuracy, efficiency, and throughput.</li><li>
Document trends, issues, and resolutions to support auditability and continuous operational improvement.</li></ul><div><b>
Cross-Functional Collaboration</b></div><ul><li>
Work closely with BMMS IT, BAMTECH, BTS, Finance, Data Reporting, and MBR vendors to coordinate root cause investigations, technical fixes, and operational adjustments.</li><li>
Support Operating Unit staff by analyzing medical bill issues, guiding next steps, and ensuring a consistent, professional experience.</li><li>
Build and maintain strong relationships with internal teams, external vendors, clients, and medical providers.</li></ul><div><b>
Project Leadership</b></div><ul><li>
Serve as the lead business resource for regulatory audit responses, coordinating data gathering, vendor input, and documentation review prior to submission.</li><li>
Lead reconsideration projects, including impact analysis, bill resubmission coordination, and monitoring outcomes.</li><li>
Partner with Business Analysts on MBR-related initiatives such as API implementations, vendor transitions, mailroom integrations, and payment process enhancements.</li></ul><div><b>
Professional Standards &amp; Administration</b></div><ul><li>
Manage assignments in alignment with standard operating procedures, meeting requirements, and departmental expectations.</li><li>
Maintain issue tracking and ensure timely escalation of complex matters.</li><li>
Demonstrate professionalism, tact, and discretion in all interactions, contributing positively to department morale and organizational reputation.</li></ul>
Qualifications:
<ul><li>MBR business process SME including experience with MBR E2E process from a business/operations perspective; firm understanding of integrated services and workflows including FS/UCR, Nurse and code review, PPO, negotiations, adjustor bill adjudication; workers compensation regulatory environment experience/understanding;</li><li>
Demonstrated application of successful critical thinking and complex problem solving skills;</li><li>
Experience in a role requiring deep understanding of and experience working with MBR and integrated services technology &ndash; not at a developer level &ndash; but from a business analyst perspective;</li><li>
Experience gathering business requirements and clearly documenting complex scenarios and use cases to communicate MBR issues accurately for resolution;</li><li>
Communication experience with varied audiences including leadership and peers in business/operational &amp; technology roles;</li><li>
Client-facing acumen</li><li>
Team-player</li><li>
Experience with Atlassian/JIRA/SQL</li><li>
5 years in a multi-faceted workers compensation MBR role demonstrating increasing responsibility with required skills outlined above within that time<ul><li>
or 3 years in an MBR role + 2 years in position with similar responsibilities;</li></ul></li></ul>
Additional Company Details: www.berkleymms.com The Company is an equal employment opportunity employer We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees &bull; Base Salary Range: 75k - 95k &bull; Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Additional Requirements: &bull;Domestic U.S. travel required (up to 5% of time) Sponsorship Details: Sponsorship not Offered for this Role</div>

Workers Compensation - Medical Bill Review - Operations Analyst (Remote)

Liquid Environmental Solutions

<p>Risk Analyst</p><p><b>Liquid Environmental Solutions (LES)</b></p><p>Join a Company That Protects More Than Just the Environment</p><p>At <b>Liquid Environmental Solutions (LES)</b>, we are the nation&rsquo;s leader in non-hazardous liquid waste management&mdash;protecting people, businesses, and the environment every day. Behind every safe operation is a strong risk management team.</p><p>We&rsquo;re looking for a <b>Risk Analyst</b> who thrives on solving problems, analyzing data, and driving real financial and operational impact. If you enjoy owning the full lifecycle of claims, working cross-functionally, and influencing outcomes at a strategic level&mdash;this is a high-visibility opportunity to make a difference.</p><p>What You&rsquo;ll Do</p><p>In this role, you&rsquo;ll take ownership of LES&rsquo;s <b>insurance and claims management process</b>, ensuring effective resolution, cost control, and continuous improvement.</p><p>Core Responsibilities</p><ul><li>Manage the full lifecycle of <b>Workers&rsquo; Compensation, Auto Liability, and General Liability claims</b></li><li>Oversee all insurance-related incidents from <b>initial report through resolution</b></li><li>Partner with key insurance providers including <b>Sedgwick (TPA), Alliant (Broker), and carriers</b></li><li>Monitor and challenge <b>claim reserves</b> to ensure accurate financial exposure</li><li>Identify cost-saving opportunities through:</li><li>Subrogation</li><li>Settlement strategy</li><li>Medical management</li><li>Analyze claims data and dashboards to identify <b>risk trends and operational improvement opportunities</b></li><li>Participate in <b>serious incident reviews</b> to assess exposure and litigation risk</li><li>Collaborate with leadership to implement solutions that reduce <b>claim frequency and severity</b></li><li>Serve as a liaison between LES, legal teams, insurance partners, and external stakeholders</li><li>Prepare executive-level summaries and support <b>insurance case reviews</b></li><li>Conduct monthly claim reviews to ensure timely progress and closure</li><li>Partner with Finance on <b>reserves, reporting, and cost tracking</b></li><li>Support <b>acquisitions integration</b> into LES insurance programs</li><li>Manage <b>Certificates of Insurance (COIs)</b> and renewal support</li><li>Maintain accurate incident reporting in internal systems and claims portals</li><li>Work closely with Fleet on vehicle-related claims and recovery efforts</li><li>Support safety reporting through accurate exposure data (hours, miles, etc.)</li></ul><p>What Makes This Role Different</p><ul><li><b>High impact:</b> Direct influence on company cost structure and risk exposure</li><li><b>Cross-functional visibility:</b> Work with Legal, Finance, Operations, and Executive Leadership</li><li><b>Data-driven environment:</b> Use analytics to drive smarter decisions&mdash;not just process claims</li><li><b>Growth opportunity:</b> Be part of a fast-growing, acquisition-driven company</li></ul><p>What We&rsquo;re Looking ForExperience &amp; Skills</p><ul><li>5+ years of experience in <b>Workers&rsquo; Compensation, Risk Management, or Claims</b></li><li>Strong understanding of:</li><li>Workers&rsquo; Compensation laws and regulations</li><li>Commercial Auto and General Liability claims</li><li>Experience working with <b>TPAs, brokers, and insurance carriers</b></li><li>Ability to analyze:</li><li>Loss runs</li><li>Reserve reports</li><li>Claims dashboards</li><li>Strong analytical thinking and decision-making skills</li><li>Excellent communication skills (written and verbal)</li><li>Highly organized with the ability to manage multiple claims and priorities</li><li>Proficiency in <b>Microsoft Office (Excel, Outlook, Word)</b></li><li>Comfortable working across departments and influencing outcomes</li></ul><p>Preferred</p><ul><li>Bachelor&rsquo;s degree</li><li>Experience with claims analytics and reporting tools</li></ul><p>Work Environment</p><ul><li>Office-based role with standard business conditions</li><li>Primarily sedentary with occasional light lifting</li><li>Approximately <b>10% travel</b></li></ul><p>Why LES?</p><ul><li><b>Industry leader</b> in environmental services</li><li><b>Stable, growing company</b> with strong national presence</li><li>Opportunity to <b>drive real impact</b> on safety, cost, and operations</li><li>Collaborative, team-oriented culture</li></ul><p>Apply Today</p><p>If you&rsquo;re ready to take ownership of risk management in a role where your expertise directly impacts business performance&mdash;we want to hear from you.</p><p>Pay: $90,000.00 - $95,000.00 per year</p><p>Benefits:</p><ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Parental leave</li><li>Referral program</li><li>Vision insurance</li></ul><p>Experience:</p><ul><li>end-to-end insurance claim management: 3 years (Required)</li></ul><p>Ability to Commute:</p><ul><li>Irving, TX 75063 (Required)</li></ul><p>Work Location: In person</p>

Risk Analyst - Insurance Claims

National Grid

<div><div><div><h1 class="jobSectionHeader"><b>Analyst, Absence Management</b></h1><div><div>
Team</div><div><b>
Safety, Health, Environment and Resilience</b></div><div>
Business Unit</div><div><b>
New York Jurisdiction</b></div><div>
Requisition No.</div><div><b>
7573</b></div><div><div>
City</div><div><b>
Syracuse, US, 13202</b></div></div><div>
Date posted</div><div><b>
13 April 2026</b></div></div></div><p></p><div>
</div></div><p></p><div><h1 class="jobSectionHeader"><b>
Analyst, Absence Management</b></h1><div><div><div><div><h3 class="jobSectionHeader"><b>
</b></h3></div><div><div><b><i>
National Grid is hiring an Absence Management Analyst for our Absence &amp; Disability department, based in Upstate NY, preferaby in Syracuse, NY. This is a Hybrid role with time spent in the office as needed.
</i></b></div><div></div><div>This position supports our commitment to employee wellbeing and operational excellence by ensuring effective management of employee absences and workers&rsquo; compensation cases.</div><div>
</div><div>Every day, we deliver safe and reliable energy to homes, communities, and businesses. Our people are at the heart of everything we do, and we are dedicated to supporting their health, safety, and ability to contribute to our mission. As we continue to evolve, we need team members who are proactive, collaborative, and committed to continuous improvement.</div></div></div><div><div><h3 class="jobSectionHeader"><b>
Job Purpose</b></h3></div><div><p>
The Absence Management Analyst, reporting to the Manager of Absence &amp; Disablilty, provides expert support and guidance on all employee absence-related matters. This role manages daily case consultations with third-party administrators, including assessing return-to-work eligibility. The analyst monitors and analyses absences using data analytics to determine whether absence days are protected under applicable laws. Additionally, the role supports the development and enhancement of reporting tools, including building out Power BI dashboards, to improve absence management insights and compliance with federal, state, and local leave laws such as FMLA and New York State Paid Leave programs.
</p></div></div><div><div><h3 class="jobSectionHeader"><b>Key Accountabilities</b></h3></div><div><ul><li>
Carry out daily case management consultations with Absence Management Third Party Administrators concerning employee absence and return to work issues</li><li>
Conduct monthly absence review meetings with business and Labor Relations to identify absence trends and develop return to work strategies</li><li>
Analyse claim information to support the department's decision-making process</li><li>
Monitor and distribute absence management reports so that stakeholders are fully informed on employee absence</li><li>
Maintain monitor and review workers compensation claims to ensure accurate reporting and avoid overpayment of claims</li><li>
Develop and maintain effective relationships with key stakeholders to share best practices and provide technical advice</li><li>
Manage the day-to-day relationship with the workers compensation Third Party Administrator including interpretation and application of established contractual agreements and state laws</li><li>
Monitor leave usage to prevent overuse, underuse, or policy violations</li><li>
Manage the return-to-work process to ensure seamless process for supervisors, employees and the medical team</li><li>
Ensure compliance with federal, state, and local leave laws (e.g., FMLA, NY State Paid Leave programs)</li><li>
Communicate clearly and professionally about complex or sensitive absence issues</li><li>
Support managers with attendance concerns and policy application</li><li>
Ability to make timely and effective decisions</li></ul></div></div><div><div><h3 class="jobSectionHeader"><b>
Qualifications</b></h3></div><div><p><b>
Required:</b></p><ul><li>
Minimum of 3 years of experience in one or more of the following related fields: absence management, workers&rsquo; compensation administration, employee health and wellbeing, human resources with a focus on leave and absence management, occupational health, disability case management, or labor relations related to absence and return-to-work processes.
</li><li>Excellent written and verbal communication skills</li><li>
Effective relationship/stakeholder management skills</li><li>
Proficient in Microsoft Office (Excel, Word, PowerPoint)</li></ul><p><b>
Preferred:</b></p><ul><li>
Bachelor&rsquo;s Degree</li></ul></div></div></div><p><b>
Salary</b></p><p><b>
$78,000 - $91,000 a year</b></p><p>
National Grid utilizes an assessment that evaluates the job qualifications/characteristics using AI or statistically based scoring. For more information, please view NYC Local Law 144.</p><p>
This position has a career path which provides for advancement opportunities within and across bands as you develop and evolve in the position; gaining experience, expertise and acquiring and applying technical skills. Candidates will be assessed and provided offers against the minimum qualifications of this role and their individual experience.</p><p>
National Grid is committed to providing equal employment opportunities to all employees and applicants for employment regardless of protected class. We do not discriminate on the basis of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other protected status in accordance with applicable federal, state, and local laws. National Grid maintains affirmative action programs for individuals with disabilities and protected veterans.</p><p>
Our employment practices are designed to ensure that all individuals are treated fairly and with respect throughout the hiring process and during employment. National Grid complies with all applicable federal, state, and local anti-discrimination laws. We are dedicated to fostering a workplace that is free from unlawful discrimination and harassment, and we encourage a culture of respect for all.</p><p>
#LI-BP1</p></div></div></div><div></div>

Analyst, Absence Management

Midwestern Insurance Alliance

<div><div><p>Midwestern Insurance Alliance (MIA) is seeking a full-time California Workers&rsquo; Compensation Assistant to join its workers&rsquo; compensation claims processing team Remotely.</p><p>
MIA is a program administrator offering custom-tailored workers&rsquo; compensation insurance programs through its carrier partners. MIA&rsquo;s acquisition by San Diego-based K2 Insurance Services in 2012 has enabled MIA to expand its product offerings and product distribution channels.</p><p><b>
Pay Range: $29.81&ndash;$31.25 USD/hour</b></p><p>
Workers&rsquo; Compensation Claims Assistant responsibilities include, but are not limited to:</p><ul><li>
Input First Report of Injuries into claims system and related duties at time of receipt.</li><li>
Assist in obtaining police reports on accident claims.</li><li>
Manage incoming faxes and distribute them to the appropriate individual for handling.</li><li>
Handle incoming mail. Prepare and process outgoing mail.</li><li>
Perform as an administrative assistant to the Claims Manager.</li><li>
Upload and index into paperless filing system.</li><li>
Handle claim calls.</li><li>
Provide switchboard relief.</li><li>
Assist in other duties as requested.</li></ul><p>
The ideal Workers&rsquo; Compensation Claims Assistant will have:</p><ul><li>
Some post-high school education.</li><li>
Strong verbal and written communication skills.</li><li>
Strong organizational skills with attention to detail.</li><li>
Ability to work with little supervision.</li><li>
Ability to manage multiple tasks in a fast-paced environment.</li><li>
Proficiency in MS Word, Excel, and Outlook.</li><li>
At least 1 year of California specific administrative or claims support experience.</li></ul><p>
MIA offers the opportunity to join an established company in growth mode. Our benefits package includes medical, dental, vision, disability, and life insurance and 401(k) with employer match. We also offer a business casual work environment and an 8:00-5:00 Monday-Friday work week.</p><p>
Learn more about MIA at midwesterninsurance.com and K2 Insurance Services at k2ins.com.</p></div></div>

California Workers’ Compensation Assistant - REMOTE

State of Ohio

<p></p><div><div><p><i>BWC&rsquo;s core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC&rsquo;s seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.</i></p><p><b>
What our employees have to say:</b><br>
BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:</p><ul><li>
BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.</li><li>
I have worked at several state agencies and BWC is the best place to work.</li><li>
Best place to work in the state and with a sense of family and support.</li><li>
I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.</li><li>
I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.</li></ul><p>
If you are interested in helping BWC grow, please</p><p><b>
What You&rsquo;ll Be Doing:</b></p><ul><li><p>
Manages a caseload of Workers&rsquo; Compensation claims: Communicates, coordinates &amp; collaborates with internal &amp; external stakeholders (e.g. Disability Management Coordinator [DMC], Medical Service Specialist [MSS], Managed Care Organization [MCO], Employer Management [EM] team, Safety &amp; Hygiene, injured workers, employers, Third Party Administrators [TPA] &amp; rehabilitation personnel) in order to set return to work expectations.</p></li><li><p>
Performs initial/subsequent claims investigation &amp; determination within prescribed timeframes:<b> </b>Contacts parties involved in claim process; completes investigation during initial claim development to determine information pertinent to management of claim (e.g., jurisdiction, coverage, causality, compensability, claim data accuracy, current work status of claimant, job description, salary continuation, physical demands of job, &amp; work history of claimant).</p></li><li><p>
Processes various types of compensation ranging from Temporary Total (TT) Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, to Lump Sum Advancement requests; addresses subsequent requests by parties to claim via due process notification, investigation, BWC orders &amp; referrals to the Industrial Commission (IC) of Ohio</p></li><li><p>
Responds to customer inquiries</p></li><li><p>
Follows Ohio Revised Code and BWC policies and procedures</p></li><li><p>
Communicates with legal representatives, employers, claimants, etc.</p></li></ul><b>
Why Work for the State of Ohio</b><p>
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:</p>
<ul>
<li>Medical Coverage</li>
<li>Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period</li>
<li>Paid time off, including vacation, personal, sick leave and 11 paid holidays per year</li>
<li>Childbirth, Adoption, and Foster Care leave</li>
<li>Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)</li>
<li>Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) &amp; Optional Deferred Compensation (Ohio Deferred Compensation)</li>
</ul>
<ul><li>Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.</li></ul><b>
Qualifications</b><div>
36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 35 words per minute.
<br>
<br>
<ul><li>Or Completion of undergraduate core coursework in business, humanities, social &amp; behavioral science, education or related field; successful completion of one typing course or demonstrate ability to type 35 words per minute.
</li></ul><br>
-Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate &amp; in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT &amp; taking appropriate action on self- insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers &amp; updating claim information, &amp; managing caseload of self-insured medical &amp; disability claims to ensure compliance with Ohio Workers' Compensation Law).
<br>
<br>
<ul><li>Or 24 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &amp;/or answering complaints, questions &amp;/or telephone inquiries &amp;/or written correspondence from customers pertaining to claims status or procedures, reviewing &amp; analyzing claims, referring customers to available community services, &amp; conducting telephone interviews with citizens reporting fraud allegations) &amp;/or as BWC Employer Service Representative, 63521, (i.e., providing information &amp; assistance &amp;/or responding to complaints, questions &amp; inquiries from customers regarding workers&rsquo; compensation coverage, established binder/applications maintenance, demographics, supplemental &amp; legal entities, manual classifications, debits/credits &amp; payroll reports &amp;/or various BWC programs &amp; research &amp; explain employer refunds, attorney general balances, payments made to policies &amp;/or divided credits).
</li></ul><br>
<ul><li>Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims &amp; paying medical claims for Ohio Bureau Of Workers' Compensation).
</li></ul><br>
<ul><li>Or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &amp;/or as Workers' Compensation Claims Assistant, 16720 &amp;/or as Workers' Customer Service Representative, 64451 &amp;/or as Workers&rsquo; Compensation Employer Service Representative, 63521.
</li></ul><br>
<ul><li>Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment.
</li></ul><br>
<b>Job Skills:</b> Claims Examination</div>
<p><b>
Major Worker Characteristics:</b></p>
<p><b>
Knowledge of:</b> workers' compensation laws, policies &amp; procedures*; eligibility criteria &amp; procedures used for processing workers' compensation claims*; English grammar &amp; spelling; oral &amp; written business communication; public relations*; addition, subtraction, multiplication, division, fractions, decimals &amp; percentages; interviewing techniques; internet search engines &amp; navigation; medical terminology; medical diagnosis coding*; Industrial Commission processes*; claims reserving*;
</p><p><b>Skill in:</b> operation of a personal computer; typing; use of Microsoft Office software (e.g., Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (e.g., Workers&rsquo; Compensation Claims Management System, Intrafin, FMS fraud system)*; operation of office machinery (e.g. calculator, printer, copier, fax, phone); communication skills (e.g., listening, writing, reading, phone etiquette); use of internet;
</p><p><b>Ability to:</b> define problems, collect data, establish facts, &amp; draw valid conclusions; read &amp; understand medical reference manuals &amp; reports, gather, collate, &amp; classify information about data, people, or things; respond to sensitive inquiries from &amp; contacts with injured workers, employers, providers or their representatives, &amp; the public; answer routine &amp; technical inquiries from injured workers, employers, medical providers &amp; public*; make proper referrals (within agency &amp; external sources)*; diffuse potentially volatile situations; present information to others; work with a team; use International Classification of Diseases (ICD) coding manuals/system*; generate properly formatted business correspondence; read and understand compensation payment plan screens*, interpret Cognos reports*.</p><b>
Supplemental Information</b><p><b>
EEO &amp; ADA Statement:</b><br>
The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.</p><p>
The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox eeodept@bwc.ohio.gov.</p><p><b>
BWC OCSEA Selection Rights:</b><br>
This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.</p><p><b>
Salary Information:</b><br>
Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.</p><p><b>
Educational Transcripts:</b><br>
For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.</p><p>
All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.</p><p><b>
Background Check:</b><br>
Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.</p><b>
ADA Statement</b><p>
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.</p><b>
Drug-Free Workplace</b><p>
The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.</p></div></div>

WC Claims Specialist (PN: 20069075 & 20069204)

State of Wyoming

<div><div><div><div><div><b>Salary</b></div>
</div><div><div>$24.78 Hourly</div>
</div></div><div><div><div><b>Location
</b></div></div><div></div><div><div>Cheyenne, WY</div>
</div></div></div><div><div><div><div><b>Job Type</b></div>
</div><div><div>Permanent Full-time</div>
</div></div><div><div><div><b>Job Number</b></div>
</div><div><div>2026-01014</div>
</div></div></div><div><div><div><div><b>Department</b></div>
</div><div><div>Department of Workforce Services</div>
</div></div><div><div><div><b>Division</b></div>
</div><div><div>Worker's Comp - Cheyenne</div>
</div></div></div><div><div><div><div><b>Opening Date</b></div>
</div><div><div>04/07/2026</div>
</div></div><div><div><div><b>Closing Date</b></div>
</div><div><div>Continuous</div>
</div></div></div><div><div><div><div><b>FLSA</b></div>
</div><div><div>Non-Exempt</div>
</div></div><div><div><div><b>Job Classification</b></div>
</div><div><div>BEWC07</div></div></div></div></div>
<br><div><div><div><h2 class="jobSectionHeader"><b>Description and Functions</b></h2></div><br>
<p></p><div><br>
<br>
<div><b>Open Until Filled</b></div><div></div><div><b><br>
GENERAL DESCRIPTION:</b><br>
<br>
The <b>Wyoming Department of Workforce Services</b> is seeking a detail-oriented and analytical <b>Claims Specialist</b> to join its Workers&rsquo; Compensation team.</div><p>
In this role, you will perform comprehensive case management functions for assigned employer accounts, ensuring the timely and accurate handling of Workers&rsquo; Compensation claims. Responsibilities include determining the compensability of claims based on statute and policy, reviewing documentation, analyzing facts, and making sound, well-supported decisions.</p><p>
The position also monitors claims activity for potential fraud, abuse, or other improprieties, helping safeguard the integrity of the Workers&rsquo; Compensation program. This role requires strong critical thinking skills, attention to detail, and the ability to communicate clearly and professionally with employers, injured workers, medical providers, and other stakeholders.</p><p>
If you are committed to public service and take pride in ensuring fair, consistent, and accountable claims administration, we encourage you to apply.</p><p><b>
Working for the State of Wyoming offers more than a paycheck. Our total compensation package includes:</b></p><ul><li>
Comprehensive health, dental, and vision insurance</li><li>
Paid vacation, sick leave, FMLA and holidays</li><li>
Retirement - Pension and 457B plans that help you build a secure future</li><li>
Flexible schedules and work-life balance options</li><li>
Meaningful work that makes a difference for Wyoming communities and MUCH MORE<b>!</b></li></ul><p><b><i>
Click here for detailed information</i></b><b><i>, or </i></b><b><i>you can watch this short video to learn about our benefit package!</i></b></p><p><b>
Want to see the full value of your compensation beyond salary?</b></p>
Explore our Total Compensation Calculator:<b> </b><b>https://compensationcalculator.wyo.gov</b><br>
<br>
<b>Human Resource Contact: </b><b>kelly.gayer@wyo.gov</b><br>
<br>
<b>ESSENTIAL FUNCTIONS</b>: The listed functions are illustrative only and are not intended to describe every function that may be performed at the job level.<div><br>
</div><ul><li>
Use case management skills to guide customers through the Workers' Compensation benefits program.</li><li>
Review injury reports.</li><li>
Investigate the circumstances of the injury.</li><li>
Make eligibility determinations on the claim for benefits by reviewing applications and medical reports.</li><li>
Process claims for indemnity benefits.</li><li>
Communicate clearly the rights, responsibilities, and benefits of the Workers' Compensation program.</li><li>
Assist injured workers with filing requirements and understanding the complex claims processes.</li><li>
Refer appropriate cases for hearing, and may provide testimony in the hearings.</li><li>
Respond directly to employers or vendors in regard to questions on procedures or the status of cases or claims.</li><li>
Coordinate return to work and work restrictions with healthcare providers and employers.</li><li>
Analyze medical documentation to determine the compensability of claims.</li><li>
Initiate and monitor program requirements and process benefits.</li><li>
Mediate disputes involving injured workers, employers, healthcare providers, and the division.</li><li>
Coordinate with healthcare providers to effectively manage the compensable injury and establish appropriate diagnoses and treatment plans for the injury.</li></ul></div><br>
<p></p>
<div><h2 class="jobSectionHeader"><b>Qualifications</b></h2></div><br>
<div><p><br>
<b>PREFERENCES:</b><br>
<br>
Preference may be given to those with Claims Management and/or Claims Service experience.<br>
Preference may be given to those with Customer Service experience.<br>
Preference may be given to those with a Bachelor's degree in Management and/or Social Services.<br>
<br>
<b>KNOWLEDGE:</b></p><br>
<ul><li>
Knowledge of Workers' Compensation Law and Rules &amp; Regulations.</li><li>
Ability to assist clients in working through complex processes.</li><li>
Ability to work independently.</li><li>
Ability to analyze situations and provide resolutions within the statutes.</li><li>
Knowledge of medical terminology</li><li>
Knowledge of case management</li><li>
Knowledge of customer service</li></ul><br>
<b>
MINIMUM QUALIFICATIONS:</b><div><br>
<b>
Education:</b></div><div>
Bachelor's Degree</div><b>
</b><div><b>
Experience</b>:</div><div>
0-1 year of progressive work experience (typically in Benefits and Eligibility)</div>
<div><b>
OR</b></div><b>
</b><div><b>
Education &amp; Experience Substitution:</b></div><div>
3-4 years of progressive work experience (typically in Benefits and Eligibility)</div>
<div><b>
Certificates, Licenses, Registrations:</b></div><div>
None</div></div><br>
<p></p>
<div><h2 class="jobSectionHeader"><b>Necessary Special Requirements</b></h2></div><br>
<div><p><br>
<b>NOTES:</b></p><br>
<ul><li>
FLSA: Non-Exempt</li><li>
Former State of Wyoming employees who are rehired less than 31 days after their final day in their old agency, must repay all leave payouts.</li><li>
The Wyoming Department of Workforce Services (DWS) uses E-Verify, an Internet-based system, to confirm the eligibility of all newly hired employees to work in the United States. Learn more about E-Verify, including your rights and responsibilities.</li><li>
For the Veteran's preference consideration, supporting documentation must accompany your application.</li><li>
Offers of employment will be contingent upon the successful completion of a background check.</li></ul></div><br>
<p></p>
<div><h2 class="jobSectionHeader"><b>Supplemental Information</b></h2></div><p></p><div><p><br>
Click here to view the State of Wyoming Total Compensation Calculator.</p><p>
URL: http://agency.governmentjobs.com/wyoming/default.cfm<br>
<br>
The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.<br>
<br>
<i>Class Specifications are subject to change, please refer to the A &amp; I HRD Website to ensure that you have the most recent version.</i></p></div></div></div><p></p>

Claims Specialist 2026-01014

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