Workers' Comp Claims Specialist

Job Title:  PEO Workers’ Compensation Claim Specialist 

Department: Worker's Compensation

Reports To:  Workers’ Compensation Claims Manager

Why Join Us:

At Consolidated Personnel Services, Inc., we pride ourselves on delivering exceptional workers’ compensation claims solutions to our clients. As a WC Claims Specialist, you will play a pivotal role in driving our success and ensuring the highest level of service for our client organizations.

Job Summary:  We are seeking a highly organized and detail-oriented WC Claims Specialist to join our team at Consolidated Personnel Services, Inc., Professional Employer Organization (PEO). This role is responsible for managing and coordinating all aspects of workers' compensation claims, ensuring compliance with state and federal regulations, and supporting injured employees throughout the claims process. The ideal candidate will have a strong understanding of WC laws, claims administration, and case management, with prior experience as a claims adjuster considered a significant plus. The WC Specialist will serve as a liaison between employees, insurance carriers, medical providers, and internal departments to facilitate timely and accurate claims resolution. This position requires excellent communication, analytical, and problem-solving skills, as well as the ability to handle sensitive information with discretion and professionalism.

Key Responsibilities:

• Manage end-to-end workers' compensation claims, including intake, documentation, follow-up, and closure, ensuring accuracy and compliance with legal and company guidelines.
• Evaluate claims to review eligibility for benefits and ensure proper documentation is provided.
• Provide guidance and support to injured employees, ensuring they understand their rights and responsibilities.
• Coordinate and facilitate communication between our clients, injured employees, and insurance carriers.
• Monitor claim status and proactively address delays and complications.
• Conduct internal investigations and gather relevant information to support claims.
• Analyze claims data to identify trends and recommend process improvements.

Investigation and Documentation:

• Investigate the circumstances surrounding workplace injuries, gather evidence, and work closely with carriers/TPA and clients to support the return-to-work process when employees have restrictions.
• Maintain accurate, up-to-date records for each claim, incident details, and financial information.

Claims Resolution:

• Collaborate with adjusters and nurse case managers to ensure proper treatment plans are in place for injured workers and monitor progress.
• Communicate claim decisions with clients.
• Ensure claims are resolved in a timely manner, adhering to company policies and applicable laws.
• Notify payroll/benefits teams of lost time claims and provide pre-injury wage information to the carrier as required.

Compliance and Reporting:

• Ensure compliance with federal, state, and local workers' compensation regulations and laws.
• Proficient knowledge in preparing and reviewing state forms to the insurance companies and regulatory agencies.
• Complete new claim investigations, gathering verbal statements from employees and witnesses as needed.
• Promptly prepare and submit the 101 forms to the appropriate insurance carrier, providing relevant information from the employer's investigation.
• Maintain a diary system to review and oversee existing claims, ensuring that benefits are paid timely and appropriately.

Customer Service:

• Provide support and guidance to injured workers throughout the claims process, addressing questions and helping as needed.
• Function as a liaison between employers and insurers to ensure proper handling of benefits and claims.

Collaboration and Training:

• Collaborate with safety teams, HR, and legal departments to ensure proper accident reporting and injury prevention strategies.
• Assist in training other team members or staff on workers' compensation policies and procedures.

Preferred Skills and Qualifications:

• Minimum of 2-5 years of AZ lost time adjusting experience ; multi-state experience is a plus or:
• Bachelor’s degree in business, Claims Adjusting, Healthcare, Insurance, or a related field preferred.
• Certification in workers’ compensation claims management (e.g., WCCA, WCCP) is preferred.
• In-depth Knowledge of workers ‘compensation laws, OSHA regulations and disability management.
• Strong knowledge of workers' compensation laws and claims processes.
• Strong verbal and written communication skills.
• Ability to analyze data and make informed decisions.
• Customer-service oriented with the ability to oversee sensitive and confidential information.
• Excellent interpersonal and communication skills with the ability to interact effectively with clients and employees at all levels.
• Very strong attention to detail and organizational skills , with the ability to manage multiple tasks and meet deadlines.
• Proficient in Microsoft Office Suite (Excel, Word, PowerPoint, One-Note, Adobe Acrobat), and Teams.
• Ability to speak Spanish is a plus.

Work Environment:

• Full-time in office position based in Phoenix, with occasional travel to client locations as needed.
• A collaborative team environment with a focus on client service and professional development.
• Competitive salary and benefits package.

Benefits:

• 401(k) with matching
• Health Insurance
• Dental Insurance
• Vision Insurance
• Health Savings Account
• STD, LTD, GTL
• Paid time off.
• 1 day Hybrid Schedule (after 90 days)

How to Apply:  Please submit your resume and cover letter for consideration. We look forward to hearing from you!

Consolidated Personnel Services Inc. is an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.