Senior Workers' Comp Claims Specialist

New Mexico Mutual Casualty Company; Albuquerque (NM); On-site; USD 70,000 - 120,000; Full time

Job summary

NEW MEXICO MUTUAL seeks a Claims Specialist to manage complex workers' compensation claims from investigation through resolution. You will assess compensability, coordinate medical care, subrogation, and litigation strategy while applying state statutes and company policies.

Ideal candidates have 5+ years of serious WC claims experience, a valid adjuster license, and relevant certifications. Join a team focused on service excellence and outcomes.

Qualifications

• Bachelor’s degree from an accredited college or university.
• 5+ years of serious workers' compensation claims experience.
• 10+ claims handling experience.
• State required adjuster's license.
• Related professional certifications preferred

Responsibilities

• Evaluate, analyze and determine compensability, causation, offsets and exposures of serious and complex workers' compensation claims.
• Verify claim information, document history, take statements, identify subrogation opportunities, coordinate medical care.
• Document activities in the claim management system and manage outside counsel assignments and RTW strategies.
• Set and monitor reserves, issue benefit checks, apply state statutes and company policies.
• Ensure timely and accurate statutory/benefit payments within deadlines.
• Prepare/participate in mediation conferences and regulatory proceedings.
• Maintain diary on open claims and ensure audit trails.
• Assess litigation for financial exposure and report trends for improvements.
• Mentor junior adjusters and support Claims Manager as directed.
• Detect suspected insurance fraud and maintain records in compliance with laws.

Skills

Claim handling

Serious claims

Investigation

Negotiation

Litigation management

Subrogation opportunities

Medical case management

Return-to-work

Mentoring

Regulatory/compliance knowledge

Education

Bachelor’s Degree

Job description

NEW MEXICO MUTUAL seeks a Claims Specialist to manage complex workers' compensation claims from investigation through resolution. You will assess compensability, coordinate medical care, subrogation, and litigation strategy while applying state statutes and company policies.

Ideal candidates have 5+ years of serious WC claims experience, a valid adjuster license, and relevant certifications. Join a team focused on service excellence and outcomes.