Workers' Compensation Claims Specialist

HSM Worx; Muntinlupa; On-site; PHP 502,000 - 837,000; Full time

Job summary

HSM Worx in the Philippines is seeking a Workers' Compensation Claims Specialist to oversee end-to-end claims for a USA-based nursing group. This on-site graveyard shift role requires coordinating with injured employees, HR, and insurance adjusters to ensure timely medical care and accurate reserves.

The ideal candidate will have 2–4 years in claims administration, strong English communication, and the ability to manage multiple open claims with meticulous documentation from Alabang.

Qualifications

• 2–4 years in workers' compensation claims administration or related field.
• Knowledge of U.S. workers' compensation processes and reserves.
• Strong written and spoken English for professional interaction with employees, HR, and insurers.
• On-site graveyard shift availability at Alabang office.

Responsibilities

• Manage a caseload of open workers' compensation claims from first report through closure.
• Report new claims to the insurer and ensure proper setup.
• Serve as the point of contact for injured employees and verify medical care.
• Coordinate with claims adjusters to monitor status and drive timely closure.
• Review reserves for accuracy and flag unsupported exposure.
• Maintain audit-ready documentation in the claims system.
• Escalate trends toward litigation, extended lost time, or high costs.
• Collaborate with HR on return-to-work timing and documentation.
• Report on claim volume, status, and aging to leadership.

Skills

English communication

Attention to detail

Organizational skills

Multitasking

Tools

Claims management system

Job description

About the role

The Workers Compensation claims specialist will oversee end-to-end workplace injury claims for our client, a USA based Skilled Nursing Group. From first report through claim closure, this role serves as the primary liaison between injured employees, HR, and the insurance carrier's claims adjusters, ensuring injured workers receive timely medical care while managing claim costs and reserves on behalf of the company.

This is an on-site graveyard shift role so that you can reach adjusters, carriers, and client HR during U.S. business hours.

What You'll Do

• Manage a caseload of open workers' compensation claims from first report through closure.
• Report new claims to the insurance carrier and confirm each one is set up correctly.
• Serve as the point of contact for injured employees, keeping them informed and confirming they are receiving appropriate medical care.
• Work with claims adjusters to monitor status, clear outstanding items, and drive claims toward timely closure.
• Review claim reserves for accuracy and raise exposure that does not match the facts of the claim.
• Maintain complete, audit-ready documentation for every claim in the claims management system.
• Escalate claims trending toward litigation, extended lost time, or unusual cost.
• Coordinate with HR on return-to-work timing and documentation.
• Report on claim volume, status, and aging to HSM Worx and client leadership.

Requirements

• 2 to 4 years in workers' compensation claims administration, risk management, or a related field.
• Working knowledge of U.S. workers' compensation processes, medical treatment protocols, and claims/reserve management.
• Strong spoken and written English, with the ability to interact professionally with employees, HR staff, and insurance carrier representatives.
• Highly organized, with strong follow-through and attention to detail.
• Ability to manage multiple open claims simultaneously and prioritize effectively.
• Availability to work the graveyard shift on-site in our Alabang office.