Senior Claims Specialist

Roles and Responsibilities
- Assist in managing workers’ compensation claims from initial report through closure for designated clients.
- Partner with the appointed TPA to ensure compliance with service agreements, including:
- Reviewing basic claim details and supporting documentation.
- Monitoring reserves and ensuring adherence to Standard Service Instructions (SSIs).
- Provide clear status updates and route escalations when higher-level intervention is required.
- Support return-to-work (RTW) follow-up and ensure client expectations are met throughout the claim lifecycle.
- Monitor critical claim-related deadlines, including wage filings, state form submissions, and medical updates.
- Assist the Claims Manager in preparing materials for claim reviews, carrier discussions, internal presentations, and departmental reporting.
- Identify and provide solutions for process gaps. Uphold privacy, confidentiality, and data governance standards.
- Assist in preparing materials for claim reviews, carrier discussions, internal presentations, and departmental reporting.
- Contribute to internal reporting, including loss runs, data validation, and performance metrics.
- Run recurring and ad hoc reports to validate data and identify discrepancies.
What We’re Looking For
- 3+ years of experience in U.S. Workers’ Compensation Claims
- Experience with the U.S. P&C insurance domain
- Understanding of the WC claims lifecycle – FNOL to closure
- Exposure to TPA/carrier coordination
- Knowledge of reserves, loss runs, medical updates and RTW
- Understanding of U.S. state-specific Workers’ Compensation requirements
- Exposure to master carriers / monopolistic state funds will be an advantage
- Strong analytical, organizational and communication skills
- Comfortable working in a night shift

Work arrangement
No