Sr Workers Compensation Claims Analyst III

Primary Responsibilities:

•   Independently investigate, evaluate, negotiate, manage, and resolve complex workers' compensation claims in a good faith manner..          
• Serve as a subject matter expert for workers' compensation regulations, claim handling best practices, and emerging industry trends.
•  Analyze medical, legal, vocational, and financial information to determine reserves, compensability, liability exposure, and settlement opportunities.         
• Provides recommendations to management regarding litigation, settlement authority, and risk mitigation.
• Partner with legal counsel, medical providers, third-party administrators, brokers, and regulatory agencies to facilitate claim resolution.
• Perform quality reviews and audits of claim files to ensure consistency, compliance, and adherence to organizational standards.
• Act as a mentor and resource for Claims Analysts I and II, providing coaching, knowledge transfer, and claims guidance.
• Lead special projects, process improvement initiatives, and cross-functional efforts related to workers' compensation operations.
• Maintain accurate documentation and timely claim handling activities in accordance with company standards and jurisdictional requirements.
• Demonstrates advanced proficiency in leveraging emerging technologies, automation tools, and AI resources to optimize claim handling operations, drive process improvements, and elevate customer service outcomes.         
• Serves as a resource to others by promoting technology adoption, identifying innovative solutions, and influencing best practices that improve efficiency, accuracy, and organizational performance.

Knowledge and Requirements:

•  High School Diploma or GED required. Bachelor's degree in Business, Risk Management, Insurance, Human Resources, or related field preferred.
• Minimum 5+ years of workers' compensation claims handling experience.        
• Demonstrated experience handling complex, litigated, and high-exposure workers' compensation claims.
• Advanced knowledge of workers' compensation laws, regulations, and claims practices across multiple jurisdictions.
• Proven ability to independently manage large claim inventories and complex investigations.
• Strong analytical, negotiation, and decision-making skills.
• Excellent written and verbal communication skills.
• Advanced proficiency with claims management systems and Microsoft Office applications.
• Ability to exercise sound judgment and discretion in sensitive situations.
• Travel as needed to customer locations, hearings, mediations, or claim-related meetings.
• Associate in Claims (AIC), CPCU, ARM, WCP, or other industry designation preferred.

 

#HO

#LI-TH1