Oliver James

Compensation

Full Description

We are seeking a skilled Complex Claims Specialist with extensive Workers’ Compensation experience to manage a diverse portfolio of challenging claims. This role offers the opportunity to work on high-exposure cases, collaborate with senior leadership, defense counsel, and medical providers, and contribute to the development of strategy and best practices. Ideal position for a seasoned professional looking to make a meaningful impact in a supportive and growth-oriented environment. As a Complex Claims Specialist, you will be responsible for managing catastrophic and complex Workers’ Compensation claims from investigation through resolution. This includes evaluating coverage, determining compensability, and setting and maintaining appropriate reserves. You will make independent recommendations on high-value claims, participate in strategy and reserving discussions, and ensure compliance with applicable regulations. You will collaborate with outside defense counsel, medical providers, and other stakeholders to drive fair and efficient claim resolutions. Your responsibilities also include identifying subrogation opportunities, managing litigated files in line with litigation guidelines, and developing creative strategies to resolve complex issues. Additionally, you will act as a resource and mentor for less experienced team members and assist in training and onboarding new hires. To succeed in this role, you will need at least 10 years of experience handling complex Workers’ Compensation claims, an active adjuster license, and expertise in areas such as structured settlements and Medicare Set-Asides. Strong analytical skills, excellent communication, and the ability to effectively manage multiple priorities in a remote work environment are essential. This is a remote position with occasional travel for mediations, training, and team meetings. In return, you will receive competitive compensation, generous paid time off, 401(k) with company match, comprehensive health coverage, tuition reimbursement, and career development support. Apply Now