Complex Claims Specialist - WC (WEST)

Job DescriptionComplex Claims Specialist - Workers' Compensation (Remote) Job Summary Seeking an experienced Complex Claims Specialist with a strong background in handling complex Workers' Compensation claims. This role involves managing a caseload of high-severity claims, including catastrophic injuries, across multiple jurisdictions. The ideal candidate will possess extensive knowledge of Workers' Compensation regulations, laws, and best practices. This is a 100% remote position with occasional travel required for mediations, training, and departmental meetings. Compensation Package Salary Range: $100,000 - $125,000 (depending on experience) Competitive benefits package, 401(k), paid time off, professional development opportunities, etc. Responsibilities As a Complex Claims Specialist, your key responsibilities will include: Investigating coverage, determining compensability, and managing high-exposure Workers' Compensation claims involving catastrophic injuries and complex cases. Establishing and updating reserves throughout the claim lifecycle to reflect exposure, with documented rationale. Resolving claims within authority limits and making case value recommendations to senior leadership for cases exceeding authority. Collaborating with outside defense counsel to manage litigated files in accordance with established guidelines. Partnering with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills. Ensuring compliance with state and federal Workers' Compensation regulations. Providing exceptional customer service to policyholders, agents, injured workers, medical providers, legal teams, and vendors. Developing creative resolution strategies for complex cases, utilizing internal and external resources effectively. Documenting claim files in accordance with company and regulatory guidelines. Identifying subrogation potential and red flags requiring Special Investigations Unit (SIU) involvement. Training new team members and acting as a technical resource for less experienced claims representatives. Maintaining continuing education requirements. Qualifications/Requirements Knowledge and Experience: Active adjuster license required. Minimum of 10 years of experience handling complex Workers' Compensation claims. Multi-state experience in jurisdictions such as California, Arizona, Colorado, Wyoming, Texas, and Oklahoma (willingness to learn additional jurisdictions is required). Proficiency in structured settlements and Medicare Set-Asides. Strong negotiation, analytical, organizational, and time management skills. Ability to work independently in a fast-paced, virtual office environment. Advanced verbal and written communication skills for interacting with internal and external stakeholders. Proficiency in MS Word, Excel, and internet applications. Highly detail-oriented with the ability to prioritize tasks effectively under pressure. Education: Bachelor's degree required. Industry designations such as AIC, SCLA, or CPCU are a plus. Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion. #LI-BC1

Created: 2026-03-04