Senior Claims Specialist

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Senior New England Claims Specialist in the United States.

This opportunity is ideal for an experienced workers’ compensation professional who thrives in managing complex and high-exposure claims with precision and empathy. In this role, you will oversee the full claims lifecycle, collaborating with legal teams, case managers, and clients to deliver fair and cost-effective outcomes. The position offers a highly autonomous remote work environment while maintaining strong collaboration across multidisciplinary teams. You will play a key role in reducing claim costs, supporting return-to-work initiatives, and ensuring compliance with state regulations and industry standards. This role is well-suited for someone who combines analytical thinking with strong communication and negotiation skills. It also provides the chance to contribute to a supportive, growth-oriented environment focused on operational excellence and client satisfaction.

• Manage complex Workers’ Compensation claims from initial intake through resolution, ensuring accurate coverage verification and timely claim acknowledgment.
• Investigate claims thoroughly to determine validity and compensability while maintaining proper documentation and compliance with state regulations.
• Establish reserves, authorize payments within designated authority levels, and develop strategic action plans to control claim costs and optimize outcomes.
• Collaborate closely with case managers, attorneys, claimants, employers, and healthcare providers to coordinate effective claim resolution and return-to-work strategies.
• Handle litigation, subrogation opportunities, and claim recovery processes while maintaining detailed claim records and status reporting.
• Communicate proactively with clients and stakeholders to provide updates, maintain strong professional relationships, and ensure high service standards.
• Participate in claim reviews, support departmental goals, and contribute expertise to strengthen overall claims management practices.

Requirements:

• Minimum of 3 years of experience handling Workers’ Compensation claims, including exposure to complex or high-profile cases.
• Bachelor’s degree or an equivalent combination of education and relevant industry experience.
• Active Workers’ Compensation adjuster license or state certification required, with the ability to maintain credentials throughout employment.
• Self-Insured Certificate preferred.
• Strong understanding of claims administration, case management, litigation processes, and cost containment strategies within Workers’ Compensation.
• Excellent written and verbal communication skills with the ability to negotiate effectively and build trusted relationships with multiple stakeholders.
• Strong analytical, organizational, and problem-solving abilities with the capacity to manage competing priorities independently.
• Proficiency with Microsoft Office tools, including Excel, and confidence working within digital claims management systems.
• Ability to mentor or support team members while contributing positively within a collaborative remote work environment.

Benefits:

• Competitive salary range of $61,053 – $98,334, depending on experience, qualifications, location, and overall fit.
• Fully remote work arrangement offering flexibility and work-life balance.
• Comprehensive healthcare coverage including medical, dental, and vision plans.
• Health Savings Account (HSA) and Flexible Spending Account (FSA) options.
• Long-term disability, life insurance, accident insurance, and critical illness coverage.
• 401(k) and Roth 401(k) retirement savings plans.
• Paid time off and additional employee wellness benefits.
• Career advancement opportunities within a stable and growing organization.
• Supportive and collaborative workplace culture focused on accountability, integrity, and teamwork.