Workers Compensation Claims Consultant

Jobtailor; California (MO); On-site; USD 90,000 - 130,000; Full time

Job summary

Jobtailor seeks a seasoned Senior Claims Manager to lead complex workers' compensation claims, determining when to settle or litigate and guiding resolution strategies across cases. You will manage investigations, reserves, discovery, and litigation strategy, coordinating with attorneys and medical professionals while mentoring junior staff.

You will also monitor regulatory trends and provide strategic input to management.

Qualifications

• Bachelor's degree or equivalent experience.
• Typically a minimum eight years claims experience.
• Professional designation preferred.
• Advanced technical and product-specific expertise in claims resolution and insurance principles, practices and procedures.
• Strong communication, negotiation and presentation skills.
• Advanced analytical and problem-solving skills.
• Ability to manage and prioritize multiple projects.
• Knowledge of Microsoft Office Suite and other business-related software.
• Ability to evaluate claims based on cost-benefit analysis.
• Ability to comprehend and articulate complex claim facts and issues.
• Ability to implement strategies with a proactive long-term view.
• Ability to adapt to change and value diverse opinions and ideas.

Responsibilities

• Manage highly complex workers compensation claims, including coverage, liability, compensability and damages.
• Determine whether major claims should be settled or litigated and implement resolution strategies.
• Manage investigations, litigation, reserves, discovery and litigation strategy.
• Negotiate complex settlement packages and authorize payments within scope of authority.
• Coordinate third-party recovery with the subrogation/salvage unit.
• Recommend claims processes and resolution strategies to management.
• Analyze claims activities and prepare and present reports to management, internal business partners and clients.
• Work with attorneys, account representatives, agents, doctors and insureds on complex claims.
• Monitor state and territory regulations, industry activity and trends.
• Provide guidance to less experienced claims staff and other functional areas.
• Accurately input claim circumstance and business outcome data.

Skills

Advanced analytical skills

Negotiation skills

Project management

Adaptability

Team guidance

Education

Bachelor's degree

Professional designation

Tools

Microsoft Office Suite

Job description

• Manage highly complex workers compensation claims, including coverage, liability, compensability and damages
• Determine whether major claims should be settled or litigated and implement resolution strategies
• Manage investigations, litigation, reserves, discovery and litigation strategy
• Negotiate complex settlement packages and authorize payments within scope of authority
• Coordinate third-party recovery with the subrogation/salvage unit
• Recommend claims processes and resolution strategies to management
• Analyze claims activities and prepare and present reports to management, internal business partners and clients
• Work with attorneys, account representatives, agents, doctors and insureds on complex claims
• Monitor state and territory regulations, industry activity and trends
• Provide guidance to less experienced claims staff and other functional areas
• Accurately input claim circumstance and business outcome data

Requirements

• Bachelor's degree or equivalent experience
• Typically a minimum eight years claims experience
• Professional designation preferred
• Advanced technical and product-specific expertise in claims resolution and insurance principles, practices and procedures
• Strong communication, negotiation and presentation skills
• Advanced analytical and problem-solving skills
• Ability to manage and prioritize multiple projects
• Knowledge of Microsoft Office Suite and other business-related software
• Ability to evaluate claims based on cost-benefit analysis
• Ability to comprehend and articulate complex claim facts and issues
• Ability to implement strategies with a proactive long-term view
• Ability to adapt to change and value diverse opinions and ideas

Core Competencies

Demonstrates advanced expertise in managing complex workers compensation claims, including coverage, liability, and damages, while effectively negotiating settlements and implementing resolution strategies. Proficient in analyzing claims activities and presenting findings to management and stakeholders.

Highest-signal resume keywords

• Workers Compensation Claims Management
• Claims Resolution Strategies
• Advanced Analytical Skills
• Negotiation Skills
• Microsoft Office Suite

ATS Optimization Keywords

Hard Skills

• Claims Analysis
• Litigation Management
• Cost-Benefit Analysis
• Claims Process Improvement
• Settlement Negotiation

Soft Skills

• Strong Communication Skills
• Problem-Solving Skills
• Project Management
• Adaptability
• Team Guidance

Certifications & Qualifications

• Professional Designation

Industry Keywords

• Insurance Principles
• Regulatory Monitoring
• Subrogation
• Claims Reporting
• Complex Claims Management

Tools & Technologies

• Business-Related Software