Senior Workers' Comp Claims Specialist

New Mexico Mutual; Albuquerque (NM); On-site; USD 60,000 - 85,000; Full time

Job summary

New Mexico Mutual in Albuquerque seeks a Claims Specialist to provide expert handling of complex workers' compensation claims, including investigation, evaluation, negotiation and litigation management under state law and company policies.

You will document all activities in the claim system, set reserves, coordinate medical care, participate in mediation or regulatory proceedings, and mentor junior adjusters while upholding service excellence.

Qualifications

• Bachelor's degree required.

Responsibilities

• Evaluate compensability, causation, offsets and exposures of serious and complex workers' compensation claims.
• Document all activities in the claim management system and coordinate with outside legal counsel when needed.
• Set and monitor reserves; issue benefit payments in accordance with state statutes and company policies.
• Prepare for mediation conferences and participate in regulatory proceedings as required.
• Mentor junior adjusters and support Claims Managers.
• Identify and report potential fraud and ensure accurate audit trails.

Skills

Claim handling

Workers' compensation

Negotiation

Investigation

Documentation

Mentoring

Communication

Education

Bachelor’s Degree

Tools

Claim management system

Job description

New Mexico Mutual in Albuquerque seeks a Claims Specialist to provide expert handling of complex workers' compensation claims, including investigation, evaluation, negotiation and litigation management under state law and company policies.

You will document all activities in the claim system, set reserves, coordinate medical care, participate in mediation or regulatory proceedings, and mentor junior adjusters while upholding service excellence.