Claims Management Specialist

This is a fully remote position, open to applicants in Texas.

📋 Description

• Oversees and manages workers' compensation claims from the initial report of injury to resolution and closure.

• Acts as the main point of contact between client companies, injured workers, insurance providers, claims adjusters, medical professionals, payroll, HR, and internal teams.

• Informs clients and injured employees about workers' compensation processes, reporting obligations, return-to-work initiatives, available resources, and responsibilities throughout the claims journey.

• Delivers customer service and support while ensuring all stakeholders comprehend required protocols, subsequent steps, and obligations related to claims.

• Organizes claim documentation, wage reporting, communications related to claims, and return-to-work efforts.

• Tracks claim progression and collaborates with insurers, adjusters, employers, and healthcare providers to promote effective claim resolution.

• Assesses claim statuses with insurers and adjusters, participates in client claim evaluations, and aids in gathering and analyzing claims history, loss patterns, and risk-related data.

• Maintains precise claim records, documentation, and reporting.

• Performs any additional duties as assigned.

⛳️ Requirements

• Bachelor's degree in Human Resources, Risk Management and Insurance, or a related field from an accredited four-year institution is preferred.

• A minimum of four (4) years of experience in claims management or a related field is required.

• Comprehensive understanding of workers' compensation claims processes, return-to-work initiatives, and claim resolution techniques.

• Familiarity with OSHA regulations, workplace safety standards, and accident prevention programs is preferred.

• Bilingual (Spanish) proficiency is mandatory.

• Excellent organizational abilities to manage multiple tasks, meet deadlines, and maintain a keen attention to detail.

• Capacity to analyze information, solve issues, and apply sound judgment.

• Proficient in clear and concise written communication.

• Strong customer service and relationship management capabilities to effectively engage with clients, injured employees, carriers, and internal teams.

• Ability to sit and stand for extended periods while performing sedentary tasks.

• Must maintain required certifications.

• Must successfully pass pre-employment drug screening.

• SWBC does not employ tobacco users as permitted by law.

🏝️ Benefits

• Competitive overall compensation package.

• Work/Life balance.

• Employee engagement initiatives and recognition awards.

• Years of Service awards.

• Opportunities for career advancement and growth.

• Leadership Academy and Mentor Program.

• Continuing education and career certification opportunities.

• A variety of healthcare coverage options.

• Traditional and Roth 401(k) retirement plans.

• Attractive Wellness Program.