Workers' Comp Claims Specialist

Job Title:  PEO Workers’ Compensation Claim Specialist 

Department:  Human Resources

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). The Workers' Compensation Claims Specialist is responsible for evaluating, investigating, and reporting workers' compensation claims, and ensuring accurate and timely claim resolutions. This role requires a strong understanding of workers' compensation laws, excellent communication skills, and the ability to collaborate with clients, injured employees, and carriers.

Key Responsibilities:

• Process and oversee workers' compensation claims from initial reporting to closure, ensuring accuracy and compliance with legal and company guidelines.
• Evaluate claims to review eligibility for benefits and ensure proper documentation is provided.
• Oversee claims to ensure that the employee is receiving medical care related to their injuries, follow up to confirm the employee is keeping medical appointments, and monitor work status updates.
• Coordinate and facilitate communication between our clients, injured employees, insurance carriers.

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.
• Prepare state filing forms to the insurance companies and regulatory agency.
• 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.
• Monitor claim trends and advise on potential risk management improvements.

Customer Service:

• Provide support and guidance to injured workers throughout the claims process, addressing questions and helping as needed.
• Function as a liaison between employees 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.

Qualifications:

• Bachelor’s degree in business, Healthcare, Insurance, or a related field preferred.
• Minimum of 2-5 years of AZ lost time adjusting experience preferred; multi-state experience is a plus.
• Familiarity with workers' compensation laws, claims processes, and insurance regulations.
• Strong knowledge of workers' compensation laws and claims processes.
• Excellent organizational and documentation skills.
• 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.
• Certification in workers’ compensation claims management (e.g., WCCA, WCCP) may be preferred (Optional)
• Excellent interpersonal and communication skills with the ability to interact effectively with clients and employees at all levels.
• 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), 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.
• Hybrid Schedule

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.