Senior Workers’ Compensation Claims Specialist - AZ, On Site
$31,200–$31,200 year
On-siteChandler, Arizona, United States
Job Summary
Lead comprehensive investigations of complex workers' compensation claims, including coverage analysis, compensability determinations, and medical reviews, providing strategic recommendations to third-party administrator adjusters. Evaluate and respond to reserve and settlement authority requests, conducting advanced exposure assessments based on medical prognosis, litigation risk, and historical patterns to ensure fiscally sound decisions. Serve as a high-level consultant to clients on risk mitigation, analyzing claim trends, identifying systemic issues, and developing strategies to reduce workplace injuries and claim frequency. Act as a strategic liaison between clients, TPAs, defense counsel, and medical providers, ensuring coordinated case management and reduced litigation exposure through early intervention. Mentor junior claims staff, share expertise, and contribute to best-practice procedures while maintaining strict confidentiality and compliance with jurisdictional requirements.
Required Qualifications
- 4-5 years of progressively responsible multi-state workers' compensation claims experience
- Bachelor's degree preferred in Risk Management, Business Administration, Human Resources or equivalent combination of experience, skills, education
- Demonstrated expertise managing complex, high-exposure, and litigated claims
- Proven experience conducting in-depth investigations, evaluating compensability, analyzing medical documentation, and determining financial exposure
- Experience collaborating with TPA adjusters, defense attorneys, medical providers, vocational professionals, and employer leadership
- Strong background in return-to-work coordination
- Experience providing client consultation, program improvement recommendations, and training on workers' compensation practices and regulatory compliance
- Advanced professional designations such as Workers' Compensation Claims Associate/Professional (WCCA / WCCP), Associate in Claims (AIC), Associate in Risk Management (ARM), Certified Workers' Compensation Professional (CWCP) or Chartered Property & Casualty Underwriter (CPCU)
- In-depth knowledge of workers' compensation laws, statutes, and regulations across multiple jurisdictions
- Expert understanding of claims investigation techniques, compensability analysis, coverage verification, and advanced risk assessment
- Extensive knowledge of medical terminology, treatment guidelines, return-to-work principles, and rehabilitation processes
- Strong understanding of litigation processes, including legal strategy, attorney management, settlement negotiation, legal bill review, and mediation practices
- Advanced knowledge of reserve setting and financial exposure analysis, including actuarial impacts, trend evaluation, and loss forecasting
- Exceptional analytical and critical-thinking skills
- High-level communication and interpersonal skills
- Strong negotiation skills
- Advanced case-management and organizational skills
- Proficiency in claims software, medical management systems, and data tools, including advanced Excel skills
- Expert documentation and reporting skills
- Strong client-relationship and consultative skills
- Ability to build strong partnerships with clients, TPAs, medical providers, outside counsel, and internal teams
- Ability to provide compassionate, expert-level guidance to injured workers
- Ability to maintain strict confidentiality and comply with HIPAA, legal requirements, and organizational policies
- Proficiency with Microsoft Office software (Outlook, Microsoft Teams, Excel, Word, PowerPoint)
- Regular attendance at the assigned work location for our corporate office locations
- Occasional domestic travel to attend team onsite meetings, client visits, customer events, industry conferences, and training sessions
Desired Qualifications
- Bachelor's degree preferred in Risk Management, Business Administration, Human Resources or equivalent combination of experience, skills, education (including other relevant non-traditional degree programs, certifications, or job training programs) preferred
- Ideally in a third-party administrator (TPA), insurance carrier, or employer-based risk management environment
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