Remote Complex Workers' Compensation Claims Specialist

biBerk Business Insurance; Fully; Remote; CHF 83,000 - 104,000; Full time

Benefits offered by this job

Medical, vision, disability, and life

401(k) with company match

Paid time off and holidays

Tuition reimbursement program

Wellness programs

Job summary

biBerk Business Insurance is seeking an experienced Complex Workers’ Compensation Claims Specialist to manage a high-exposure caseload. The role requires deep knowledge of WC regulations and best practices, with multi-state experience preferred (CA, AZ, CO).

Remote work is offered, with occasional travel for mediations and trainings. You will report to the Workers’ Compensation Complex Claims Team Lead and collaborate with defense counsel, medical providers, and policyholders to ensure timely,

Qualifications

• Active adjuster license required or SIP.
• 10+ years of experience handling complex workers’ compensation claims.
• Excellent organizational, leadership, communication and time management skills.
• Experience with structured settlements and Medicare Set-Asides.
• Ability to work in a fast‑paced, collaborative, virtual office environment.
• Strong analytical, organizational, and time management skills.
• Excellent written and verbal communication skills.
• Ability to work independently and meet assigned deadlines.
• Strong negotiation skills.
• Ability to multi-task and effectively prioritize tasks with frequent interruptions.
• Proficiency with MS Word, Excel and internet applications.
• Highly attentive to details.
• Able to work under pressure and execute good judgment in sensitive situations.
• Advanced verbal and written communication skills are essential for interacting with internal and external stakeholders

Responsibilities

• Investigate coverage, determine compensability, and manage a pending of high exposure Workers’ Compensation claims involving catastrophic injuries and complex cases
• Proactively establish and update reserves throughout the life of the claim to reflect claim exposure and document supporting rationale
• Resolve claims within authority and make independent case value recommendations to senior leadership on cases which exceed authority
• Participate in reserving, pricing and strategy discussions with senior leadership
• Collaborate with outside defense counsel to effectively manage litigated files according to established litigation management guidelines
• Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills
• Ensure compliance with state and federal Workers’ Compensation regulations
• Provide exceptional customer service to policyholders, agents, injured workers, medical providers, legal, and vendors
• Follow escalation and reporting requirements on claims with significant exposure
• Develop creative resolution strategies to manage losses involving complex issues, effectively utilizing appropriate internal and external resources
• Document claim files in accordance with company and regulatory guidelines
• Identify subrogation potential and red flags that require SIU involvement
• Train new team members
• Act as a technical resource to less experienced claims representatives
• Maintain continuing education requirements

Skills

Active adjuster license

10+ years WC claims experience

Strong negotiation skills

Excellent communication skills

Time management

MS Word / Excel proficiency

Education

BA/BS degree

AIC, SCLA, CPCU or similar designation

Tools

MS Word

MS Excel

Job description

biBerk Business Insurance is seeking an experienced Complex Workers’ Compensation Claims Specialist to manage a high-exposure caseload. The role requires deep knowledge of WC regulations and best practices, with multi-state experience preferred (CA, AZ, CO).

Remote work is offered, with occasional travel for mediations and trainings. You will report to the Workers’ Compensation Complex Claims Team Lead and collaborate with defense counsel, medical providers, and policyholders to ensure timely,