workers compensation specialist

CCMSI

<p>Overview:<br/></p><p>Position Title: Workers' Compensation Claim Specialist<br/>Location: Las Vegas, NV<br/>Schedule: 8:00 am-4:30 pm PT<br/>Salary Range: $70,000 - $80,000<br/></p><p>Build Your Career With Purpose at CCMSI<br/></p><p>At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.<br/></p><p>We don&rsquo;t just process claims&mdash;we support people. As the largest privately owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work&reg;, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.<br/></p><p>Job Summary<br/>We are seeking a driven and compassionate Workers&rsquo; Compensation Claim Specialist to join our team and make a meaningful impact in the lives of injured workers. In this role, you will take ownership of a dedicated portfolio of claims&mdash;leading investigations, determining compensability, and guiding each case toward a fair and timely resolution.<br/></p><p>This position offers the opportunity to grow your technical expertise and can serve as an advanced development path for future supervisory or management roles. As a Claim Specialist, you play a vital role in delivering the high‑quality service our clients count on and upholding CCMSI&rsquo;s commitment to excellence.<br/></p><p>This is a full life‑cycle WC adjuster position within a TPA environment, and only candidates with proven Workers&rsquo; Compensation claims experience will be considered.<br/></p><p>Responsibilities:<br/></p><p>When we hire Workers&rsquo; Compensation Adjusters at CCMSI, we look for detail‑driven problem‑solvers who balance empathy with sound judgment, navigate complex regulations with confidence, and deliver fair, timely outcomes that support injured workers and strengthen client trust.<br/></p><p>Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.<br/>Establish reserves and/or provide reserve recommendations within established reserve authority levels.<br/>Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims. Negotiate any disputed bills or invoices for resolution.<br/>Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.<br/>Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.<br/>Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)<br/>Review and maintain personal diary on claim system.<br/>Assess and monitor subrogation claims for resolution.<br/>Compute disability rates in accordance with state laws.<br/>Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.<br/>Provide notices of qualifying claims to excess/reinsurance carriers.<br/>Compliance with Corporate Claim Handling Standards and special client handling instructions as established.<br/></p><p>Qualifications:<br/></p><p>Required:<br/></p><p>10+ years of Workers&rsquo; Compensation claims handling experience, including full claim investigation, evaluation, and resolution.<br/>Responsiveness to internal and external client needs.<br/>Strong analytical and negotiation abilities.<br/>Knowledge of all lower‑level claim position responsibilities.<br/>Adjuster&rsquo;s license may be required based on jurisdiction.<br/></p><p>Nice to Have:<br/></p><p>Bilingual (Spanish) proficiency &mdash; highly valued for communicating with claimants, employers, or vendors, but not required.<br/>Bachelor's degree is preferred but not required<br/>Professional designations such as AIC, ARM, or CPCU are preferred but not required<br/></p><p>Why You&rsquo;ll Love Working Here<br/></p><p>4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year<br/>Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance<br/>Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)<br/>Career growth: Internal training and advancement opportunities<br/>Culture: A supportive, team-based work environment<br/></p><p>How We Measure Success<br/></p><p>At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:<br/></p><p>Quality claim handling &ndash; thorough investigations, strong documentation, well-supported decisions<br/>Compliance &amp; audit performance &ndash; adherence to jurisdictional and client standards<br/>Timeliness &amp; accuracy &ndash; purposeful file movement and dependable execution<br/>Client partnership &ndash; proactive communication and strong follow-through<br/>Professional judgment &ndash; owning outcomes and solving problems with integrity<br/>Cultural alignment &ndash; believing every claim represents a real person and acting accordingly<br/></p><p>This is where we shine, and we hire adjusters who want to shine with us.<br/></p><p>Compensation &amp; Compliance<br/></p><p>The posted salary reflects CCMSI&rsquo;s good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.<br/></p><p>CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.<br/></p><p>Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.<br/>ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.<br/>Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.<br/></p><p>Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.<br/></p><p>Our Core Values<br/></p><p>At CCMSI, we believe in doing what&rsquo;s right&mdash;for our clients, our coworkers, and ourselves. We look for team members who:<br/></p><p>Lead with transparency We build trust by being open and listening intently in every interaction.<br/>Perform with integrity We choose the right path, even when it is hard.<br/>Chase excellence We set the bar high and measure our success. What gets measured gets done.<br/>Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.<br/>Win together Our greatest victories come when our clients succeed.<br/></p><p>We don&rsquo;t just work together&mdash;we grow together. If that sounds like your kind of workplace, we&rsquo;d love to meet you.<br/></p><p>#EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #ESOP #WorkersCompensation #WorkComp #WC #IND123 #LI-Hybrid<br/></p>

Workers' Compensation Claim Specialist

INFIRMARY HEALTH

<div>Overview:
<p></p>
Qualifications:
<div><b>
Minimum Qualifications</b></div><div>
Minimum 3 of most recent 5 years&rsquo; working with workers&rsquo; compensation activities in a clinic environment</div><br>
<div></div>
Responsibilities:
<div>
Performs a variety of duties and activities associated with workers&rsquo; compensation including scheduling, assigning and sequencing diagnostic and operative codes to accurately reflect each patient episode of care, filing insurance claims, billing/maintaining patient accounts, transcription and resolution of insurance/accounts related problems.</div></div>

Workers' Comp Specialist IMC

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

State of Kansas

<p></p><div><div><div><p><b>Important Recruitment Information for this vacancy:</b></p><ul><li><b>
Job Posting closes: April 24, 2026</b></li></ul><p></p><p><b>
Agency Information:
</b></p><p><b>Department of Administration, State Self Insurance Fund</b></p><p><b>
https://ssif.healthbenefitsprogram.ks.gov/</b></p><p>
Verification of identity and employment eligibility to work in the United States is required by federal law. For a list of acceptable documents that establish these criteria, please refer to the federal Form I-9. <b>While the Department of Administration (D of A) welcomes all candidates legally eligible to work in the United States, D of A does not provide sponsorships for this position.</b></p><p><b>
E-Verify:</b> Kansas Department of Administration (D of A) participates in E-Verify and will provide the federal government with your I-9 information to confirm that you are authorized to work in the U.S. For additional information regarding E-Verify, please click here. For additional information regarding Immigrant and Employee Rights (IER) please click here.</p><p></p><p><b>
About the Position</b></p><ul><li><b>
Who can apply:</b> Anyone</li><li><b>
Classified/Unclassified Service: </b>Unclassified</li><li><b>
Full-Time/Part-Time:</b> Full-Time</li><li><b>
Regular/Temporary: </b>Regular</li><li><b>
Work Schedule:</b> 8:00am &ndash; 5:00pm, Monday - Friday</li><li><b>
Eligible to Receive Benefits:</b> Yes</li><li><b>
Veterans' Preference Eligible: </b>Yes</li><li><b>
Application Deadline: </b>February 24, 2026</li></ul><p></p><p><b>
Compensation:</b></p><ul><li><b>
Hourly Salary Range: </b>$24.00 &ndash; $25.02</li><li><i>Note: Salary can vary depending upon education, experience, or qualifications.</i></li></ul><p></p><p><b>
Employment Benefits:</b></p><ul><li>
 <b>Comprehensive medical, mental, dental, vision, and additional coverage</b></li><li><b>
Sick &amp; Vacation leave</b></li><li><b>
Work-Life Balance programs: parental leave, military leave, jury leave, funeral leave</b></li><li><b>
Paid State Holidays (designated by the Governor annually)</b></li><li><b>
Fitness Centers in select locations</b></li><li><b>
Employee discounts with the </b><b>STAR Program</b></li><li><b>
Retirement and deferred compensation programs</b></li></ul><p><i>
Visit the Employee Benefits page for more information</i></p><p></p><p><b>
Position Description:</b></p><p>
The Program Specialist II position is <b>fully in office,</b> no remote available located in the State Self Insurance Fund (SSIF) of the State Employee Health Benefits Plan (SEHBP) and reports to the Claims Supervisor. This is a Level 2 position in SSIF. The working title is Claims Specialist</p><p><b>
Job Responsibilities:</b></p><p>
The primary duties and responsibilities are as follows:</p><p>
Determine compensability based on facts and according to the provisions of the Workers Compensation Act, rules and regulations, office policy and prior case law. Acknowledge and respond promptly by phone and/or in writing to inquiries from injured workers, physicians, agencies, attorneys and others. Process compensation payments for injured workers. Notify injured worker and agency in writing when the claim is determined not to be compensable. Consult and educate injured workers regarding their rights and benefits, providing them with helpful information in order to access and receive benefits. Calculate and issue indemnity benefits. Compute and order separate checks for payment of child support when applicable. Research, calculate, prepare and negotiate settlements for functional disabilities within authority outlined in SSIF policy and procedures. Complete and determine whether medical bills are reasonable and necessary before approving payment. Verify claimant reimbursement for mileage, per-diem, and out of pocket medical expenses. Maintain effective working relationships with injured workers, agency officials, medical professionals, attorneys, co-workers and management.</p><p>
Collaborate with injured workers, medical providers, Department of Administration, agency personnel and attorneys to maximize early Return to Work. Stimulate return to work discussions when injured workers have not been returned to duty. Coordinate job site evaluations or rehabilitation evaluations as necessary. Advise injured workers that other benefits such as vacation leave, sick leave and Family and Medical Leave Act may apply. Inform agency personnel office of injured workers status for the purpose of coordinating FMLA or other benefits for injured employees. Provide assistance to agencies and employees. Attend the annual DOL Workers Compensation Seminar and all technical training as determined by the administrator.</p><p>
Mediate disputes, when possible, in order to resolve issues and avoid litigation. Provide claimant's counsel with records and information upon demand. Prepare and write a summary of legal issues and theory of defense in cases which require assignment of a defense attorney to argue compensability in preliminary, regular or review and modification settings. Retain management of all claims, including authority for defense measures, forms of settlements and other activities. Obtain settlement authorization from management on all settlements.</p><p>
Receive electronic reports of accidents with a threshold up to $60,000; plan and conduct personal and telephone interviews of claimants, supervisors, witnesses and others relative to the accident (who, what, when, where, who witnessed, primary cause). Write a clear and concise summary of the investigation, findings of fact and conclusions of compensability. Collect personnel records, division records, medical records, wage statement and all other documentation as necessary to determine compensability. When necessary, report claims of fraud and/or abuse to an assistant attorney general for possible prosecution of claimants, attorneys, doctors and others. Determine if there is cause to review evidence to ensure recovery expenditures from negligent third parties, product liability and the Second Injury Fund.</p><p></p><p><b>
Minimum Qualifications</b></p><ul><li>
High School/GED</li><li>
Two years of experience interacting with clients, customers, or the public in a social service, customer service, or problem resolution setting. Education may be substituted for experience as determined relevant by the agency.</li><li>
A valid driver&rsquo;s license is required.</li><li>
The incumbent will receive training in the provision of the HIPAA Privacy Regulations and HIPAA Security Regulations as they relate to the duties of this position and is required to sign a confidentiality agreement.</li></ul><p><b>
Post Offer Requirement:</b></p><p><b>
Kansas Tax Clearance Certificate:</b> A valid Kansas Tax Clearance Certificate is a condition of employment for all employees of the State of Kansas. Applicants (including non-residents) who receive a formal job offer for a State job, are required to obtain a valid Tax Clearance within ten (10) days of the job offer. A Tax Clearance can be obtained through the Kansas Department of Revenue who reviews individual accounts for compliance with Kansas Tax Law. Please be encouraged if you have a missing tax return(s) or you owe taxes to the State of Kansas, the Kansas Department of Revenue will work with you. The Kansas Department of Revenue can set you up on a payment plan to receive a Tax Clearance so you can get a job working for the State of Kansas. The Kansas Department of Revenue can be contacted at 785-296-3199. Kansas Department of Revenue - Tax Clearance Frequently Asked Questions</p><p></p><p><b>
Recruiter Contact Information:</b></p><p><b>
Name</b>: Brianna Brandt</p><p><b>
Email</b>: brianna.brandt@ks.gov</p><p><b>
Mailing Address</b>: Department of Administration Office of Personnel Service 915 SW Harrison, Suite 260, Topeka, KS 66612</p><p></p><p><b>
Job Application Process:</b></p><ul><li>
First<b> Sign in</b> or register as a<b> New User</b>.</li><li><b>
Complete or update your contact information</b> on the Careers&gt; My Contact Information page. *This information is included on all your job applications.</li><li><b>
Upload required documents</b> listed below for the Careers&gt; My Job Applications page.</li><li>
Start your <b>draft job application</b>, upload other required documents, and <b>Submit </b>when it is complete.<ul><li>
Manage your draft and submitted applications on the Careers&gt; My Job Applications page.</li></ul></li><li><b>
Check your email</b> and <b>My Job Notifications</b> for written communications from the Recruiter.<ul><li>
Email &ndash; sent to the Preferred email on the My Contact Information page</li><li>
Notifications &ndash; view the Careers&gt; My Job Notifications page</li></ul></li></ul><p><b><i>
Helpful Resources at </i></b><i>jobs.ks.gov</i><b><i>:</i></b><i> &ldquo;How to Apply for a Job &ndash; Instructions&rdquo; and &ldquo;How to Search for a Job &ndash; Instructions&quot;</i></p><p></p><p><b>
Required Documents for this Application to be Complete:</b></p><p><b>
Upload these on the Careers - My Job Applications page</b></p><ul><li>
DD FM 214 (if you are claiming Veteran&rsquo;s Preference)</li></ul><p><b>
Upload these on the Attachments step in your Job Application</b></p><ul><li>
Resume</li><li>
Letter of Interest / Cover Letter</li></ul><p></p><p><b>
How to Claim Veterans Preference:</b></p><p>
Veterans' Preference Eligible (VPE): Former military personnel or their spouse that have been verified as a &quot;veteran&quot;; under K.S.A. 73-201 will receive an interview if they meet the minimum competency factors of the position. The veterans' preference laws do not guarantee the veteran a job. Positions are filled with the best qualified candidate as determine by the hiring manager.</p><p>
Learn more about claiming Veteran&rsquo;s Preference</p><p></p><p><b>
How to Claim Disability Hiring Preference</b></p><p>
Applicants that have physical, cognitive and/or mental disabilities may claim an employment preference when applying for positions. If they are qualified to meet the performance standards of the position, with or without a reasonable accommodation, they will receive an interview for the position. The preference does not guarantee an applicant the job, as positions are filled with the best qualified candidate as determined by the hiring manager.</p><p>
Learn more about claiming Disability Hiring Preference</p><p><b>
PLEASE NOTE</b>: The documentation verifying a person's eligibility for use of this preference should <b><i>not </i></b>be sent along with other application materials to the hiring agency but should be sent directly to OPS. These documents should be emailed to Gustavo.Victoriano@ks.gov, or can be mailed/delivered in person to:</p><p>
ATTN: Disability Hiring Preference Coordinator<br>
Office of Personnel Services<br>
Docking State Office Building<br>
915 SW Harrison, Ste 260<br>
Topeka, KS 66612</p><p></p><p><b>
Equal Employment Opportunity:</b></p><p>
The State of Kansas is an Equal Opportunity Employer. All qualified persons will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, political affiliation, disability or any other factor unrelated to the essential functions of the job.</p><p>
If you wish to identify yourself as a qualified person with a disability under the Americans with Disabilities Act and would like to request an accommodation, please address the request to the agency recruiter.</p></div></div></div><p></p>

Claims Specialist II

Elevate Patient Financial Solutions

<div><div><div><b>Elevate Patient Financial Solutions</b> is seeking detail-oriented and proactive professionals to join our team as a <b>Workers Compensation Claims Specialist</b>. This <b>remote, full-time</b> opportunity offers a consistent schedule of<b> Monday-Friday 8AM-4:30PM</b>. If you're passionate about making a meaningful impact and growing your career in a purpose-driven environment, this is your opportunity to shine!</div>
<div></div><div>In 2024, our Workers Compensation department resolved over 175,000 claims on behalf of our hospital clients and their patients.</div>
<div></div><div>In this role, you&rsquo;ll play a key part in helping hospitals and medical providers get paid for care as a result of work-related injuries. You&rsquo;ll gather important workers&rsquo; compensation details and insurance information by working closely with hospitals, employers, patients, and other sources. You&rsquo;ll also handle submitting claims and documentation to insurance carriers, reviewing payments and denials, and writing appeals when needed. Throughout the process, you&rsquo;ll stay in touch with insurance companies, employers, attorneys, and patients to make sure everything moves smoothly and providers receive the payments they&rsquo;re owed.</div>
<br>
<b>Essential Duties and Responsibilities</b></div>
<ul><li>Maintain a queue of Workers&rsquo; Compensation accounts as assigned by management.</li>
<li>Maintain quality and productivity levels set by management once full job proficiency has been achieved.</li>
<li>Contact patient&rsquo;s employer, Workers&rsquo; Compensation carrier, and injured worker via telephone and mail to obtain injury information and insurance information.
</li><li>Support patients by answering any questions about the Workers&rsquo; Compensation process.</li>
<li>Coordinate with appropriate client personnel to ensure appropriate filing guidelines are met for reimbursement.</li>
<li>Request appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition.</li>
<li>Perform manual data entry of patient accounts and/or claim forms.</li>
<li>Submit hospital and physician bills to insurance companies for payment.</li>
<li>Maintain contact with insurance adjusters/carriers, employers, and patients during the claim adjudication process to ensure that the hospital and physician bills are paid timely and in full.</li>
<li>Obtain claim status and gather supporting documentation to submit appeals.</li>
<li>Make written or verbal appeals to payers on denied claims.</li>
<li>Provide strong customer service to clients and provide responses to client inquiries within 24 hours.</li>
<li>Provide detailed updates to Elevate PFS&rsquo;s account management system and hospital/provider practice management system as account work is completed.</li>
<li>Assist in training both new and existing employees, which may include contributing specific training material.</li>
<li>Escalate complex, complicated, or challenging accounts to management to ensure accounts are progressing effectively.</li>
<li>Identify and discuss root cause issues with management.</li>
<li>Maintain and updates proper account documents in multiple systems.</li>
<li>Assist management with ad hoc inventory initiatives and other projects, as needed.</li>
<li>Review and manage patient accounts to ensure that proper documentation, payments, and necessary letters of authorization are entered correctly.</li>
<li>Maintain and adhere to compliance policies and procedures</li>
<li>Other duties as assigned.</li>
</ul>
<div><br>
<b>Qualifications and Requirements</b><br>
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.</div>
<ul><li>High School Diploma or GED
</li><li>Some college coursework preferred</li>
<li>Positive and encouraging attitude</li>
<li>Strong customer service background</li>
<li>Professional, accurate, clear, and concise communication, both verbal and written, including the ability to write routine business correspondence</li>
<li>Detailed and thorough</li>
<li>Adaptable</li>
<li>Organized and excel in time management. Ability to manage and move quickly and accurately through a large workload</li>
<li>Proven ability to be assertive in order to proactively resolve issues.
</li><li>Demonstrated ability to organize and set priorities according to changing situations and demands</li>
<li>Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.</li>
<li>Required computer skills: must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications</li>
<li>1-5 years of related experience in the field or in a related area such as:
<ul><li>Medical billing and coding</li>
<li>Medical appeals</li>
<li>Claims Adjudication</li>
<li>Insurance</li>
<li>Workers&rsquo; Compensation</li>
<li>Legal work</li>
</ul></li><li>Remote and Hybrid positions require a home internet connection that meets the company&rsquo;s upload and download speed criteria</li>
<li>Remote and Hybrid positions require a home internet connection that meets the company&rsquo;s upload and download speed criteria.</li>
</ul><div><div><b>Benefits</b><br>
ElevatePFS believes in making a positive impact not only within our industry but also with our employees &ndash;the organization&rsquo;s greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.</div>
<ul><li>Medical, Dental &amp; Vision Insurance</li>
<li>401K (100% match for the first 3% &amp; 50% match for the next 2%)</li>
<li>15 days of PTO</li>
<li>7 paid Holidays</li>
<li>2 Floating holidays</li>
<li>1 Elevate Day (floating holiday)</li>
<li>Pet Insurance</li>
<li>Employee referral bonus program</li>
<li>Teamwork: We believe in teamwork and having fun together</li>
<li>Career Growth: Gain great experience to promote to higher roles</li>
</ul><div>The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.</div>
<div></div><div>The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.<br>
<br>
<b>ElevatePFS is an Equal Opportunity Employer</b></div></div></div>

Workers Comp Claims Representative

Sedgwick

<div><p>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
</p><p></p><p>Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
</p><p>Certified as a Great Place to Work&reg;
</p><p>Fortune Best Workplaces in Financial Services &amp; Insurance
</p><p></p>Workers Compensation Claims Examiner | NY Jurisdiction | Dedicated Client
<p></p><div><p>We are seeking a highly motivated and experienced Workers' Compensation Claims Examiner to join our team. The ideal candidate will have at least 2 years of claims handling experience, with a strong background in New York jurisdictional regulations and processes. This position is responsible for managing and processing workers' compensation claims, ensuring timely and accurate decisions while adhering to all applicable laws and regulations.
</p><p>We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
</p><p></p><p><b>ESSENTIAL RESPONSIBILITIES
</b></p><ul><li><p><b>Independently </b>handle a capped caseload of workers' compensation claims, from inception to resolution, ensuring adherence to company procedures, industry best practices, and regulatory requirements.
</p></li><li><p><b>Ensure </b>compliance with New York workers' compensation laws, including timely filing of reports, adherence to benefit payment timelines, and compliance with statutory requirements.
</p></li><li><p>Negotiate settlements of claims within designated authority to reach claim resolution.
</p></li><li><p>Provide clear and effective communication with the claimant and client.
</p></li><li><p>Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
</p></li><li><p>Maintain accurate and comprehensive records in the claims management system, documenting all actions, decisions, and correspondence related to each claim.
</p></li></ul><p></p><p><b>OFFICE LOCATION
</b></p><p>Hybrid schedule if within 25 miles of Syracuse, NY office (3 days work from home)
</p><p>Remote if outside of 25 miles
</p><p></p><p><b>QUALIFICATIONS
</b></p><ul><li><p><b>Experience:
</b></p><ul><li><p>Minimum of (2) years of workers' compensation claims handling experience.
</p></li><li><p>Experience specifically with New York jurisdictional regulations, including knowledge of New York State Workers' Compensation Board rules and procedures.
</p></li><li><p>Experience with Public Entity claims management.
</p></li></ul></li><li><p><b>Education:
</b></p><ul><li><p>High school diploma or equivalent; a college degree or relevant certifications (e.g., WCCP, AIC) is a plus.
</p></li></ul></li><li><p><b>Skills and Abilities:
</b></p><ul><li><p>Strong understanding of workers' compensation claims processes, policies, and legal requirements in New York.
</p></li><li><p>Excellent written and verbal communication skills.
</p></li><li><p>Strong analytical skills with attention to detail and accuracy.
</p></li><li><p>Ability to manage multiple claims simultaneously and prioritize workload effectively.
</p></li><li><p>Proficiency with claims management software and Microsoft Office Suite (Excel, Word, Outlook).
</p></li><li><p>Ability to negotiate settlements and resolve claims disputes effectively.
</p></li></ul></li></ul><p><b>TAKING CARE OF YOU
</b></p><ul><li><p>Flexible work schedule.
</p></li><li><p>Capped Case Load.
</p></li><li><p>In-depth training.
</p></li><li><p>Sedgwick funded licensing.
</p></li><li><p>Referral incentive program.
</p></li><li><p>Opportunity to work in an agile or remote environment.
</p></li><li><p>Career development and promotional growth opportunities.
</p></li><li><p>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</p></li></ul><p></p><p><i>As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($85k-$95k). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
</i></p><p>#claimsexaminer #claims #hybrid #remote
</p><p></p><p>#LI-RK
</p></div><p></p><p>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
</p><p></p><h2 class="jobSectionHeader"><b>If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</b></h2></div>

Workers Compensation Claims Examiner | NY Jurisdiction | Dedicated Client

TEEMA Group

<div><h2 class="jobSectionHeader"><b>Workers&rsquo; Compensation Claims Examiner III</b></h2><p>
 Irving, TX (On-Site)<br>
 $36.53 &ndash; $38.46 per hour<br>
 Contract: 3&ndash;4 Months (Potential Extension)</p><h3 class="jobSectionHeader"><b>
Overview</b></h3><p>
We are seeking an experienced <b>Workers&rsquo; Compensation Claims Examiner III</b> to join a high-volume claims environment in <b>Irving, Texas</b>. This position is <b>fully on-site and requires in-office attendance five (5) days per week</b>.</p><p>
The ideal candidate will have strong expertise handling <b>Texas Workers&rsquo; Compensation indemnity claims</b> and the ability to manage claims from <b>inception through resolution</b> with minimal supervision. This role requires excellent organization, regulatory knowledge, and the ability to collaborate with internal teams, claimants, employers, and legal representatives.</p><p>
This is a great opportunity for an experienced claims professional seeking exposure within a <b>large, well-established organization</b>.</p><p></p><h3 class="jobSectionHeader"><b>
What You Will Be Doing</b></h3><ul><li>Manage <b>Texas Workers&rsquo; Compensation loss-time claims</b> from inception through closure</li><li>Investigate claims to determine <b>compensability and coverage</b></li><li>Administer <b>indemnity and medical benefits</b> in accordance with Texas Workers&rsquo; Compensation regulations</li><li>Evaluate claim exposure and maintain accurate claim documentation</li><li>Prepare <b>formal captioned reports</b> and maintain compliant claim files</li><li>Communicate professionally with <b>claimants, employers, attorneys, and internal stakeholders</b></li><li>Assist employers and injured workers in understanding the <b>Workers&rsquo; Compensation process</b></li><li>Ensure claims handling follows <b>internal best practices and client guidelines</b></li><li>Maintain strong organization while managing a <b>high-volume caseload</b></li><li>Deliver excellent customer service throughout the <b>entire life of the claim</b></li></ul><p></p><h3 class="jobSectionHeader"><b>
What You Must Have</b></h3><p>
✔ <b>Active Texas Workers&rsquo; Compensation Adjuster License</b><br>
✔ <b>5+ years of Texas Workers&rsquo; Compensation claims handling experience</b><br>
✔ Experience handling <b>loss-time claims</b><br>
✔ Experience with <b>public entity and First Responder claims</b> preferred<br>
✔ Strong understanding of <b>Texas Workers&rsquo; Compensation laws and regulations</b><br>
✔ Excellent <b>written and verbal communication skills</b><br>
✔ Ability to manage multiple claims in a <b>fast-paced environment</b><br>
✔ High School Diploma or GED required<br>
✔ Bachelor&rsquo;s Degree preferred</p><p></p><h3 class="jobSectionHeader"><b>
Work Environment</b></h3><ul><li><b>Full-time on-site role (no remote or hybrid)</b></li><li>Collaborative office environment</li><li>Daily interaction with internal teams and external stakeholders</li><li>Use of standard office equipment including computer systems and claims management software</li></ul><p></p><h3 class="jobSectionHeader"><b>
Additional Requirements</b></h3><ul><li>Ability to pass <b>background check and drug screening</b></li><li>Must be <b>authorized to work in the United States</b></li></ul><p></p><h3 class="jobSectionHeader"><b>
Apply Today</b></h3><p>
If you are an experienced <b>Texas Workers&rsquo; Compensation Claims Examiner</b> looking for an opportunity to contribute your expertise in a fast-paced claims environment, we encourage you to <b>apply today</b>.</p><p>
Email your resume</p><p>
mpalkin@teemagroup.com</p>
#Workwolf</div>

Workers Compensation Claims Examiner

Search 10000+ Workers compensation specialist jobs near you this April. New roles added regularly across leading industries. Apply today.