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Urgent! Complex Claims Specialist - WC (WEST) Job Opening In Omaha – Now Hiring The Jonus Group

Complex Claims Specialist WC (WEST)



Job description

Job Description

Complex Claims Specialist - Workers' Compensation (Remote)


Job Summary


Seeking an experienced Complex Claims Specialist with a strong background in handling complex Workers’ Compensation claims.

This role involves managing a caseload of high-severity claims, including catastrophic injuries, across multiple jurisdictions.

The ideal candidate will possess extensive knowledge of Workers’ Compensation regulations, laws, and best practices.

This is a 100% remote position with occasional travel required for mediations, training, and departmental meetings.


Compensation Package

  • Salary Range: $100,000 - $125,000 (depending on experience)

  • Competitive benefits package, 401(k), paid time off, professional development opportunities, etc.
  • Responsibilities


    As a Complex Claims Specialist, your key responsibilities will include:

  • Investigating coverage, determining compensability, and managing high-exposure Workers’ Compensation claims involving catastrophic injuries and complex cases.

  • Establishing and updating reserves throughout the claim lifecycle to reflect exposure, with documented rationale.

  • Resolving claims within authority limits and making case value recommendations to senior leadership for cases exceeding authority.

  • Collaborating with outside defense counsel to manage litigated files in accordance with established guidelines.

  • Partnering with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills.

  • Ensuring compliance with state and federal Workers’ Compensation regulations.

  • Providing exceptional customer service to policyholders, agents, injured workers, medical providers, legal teams, and vendors.

  • Developing creative resolution strategies for complex cases, utilizing internal and external resources effectively.

  • Documenting claim files in accordance with company and regulatory guidelines.

  • Identifying subrogation potential and red flags requiring Special Investigations Unit (SIU) involvement.

  • Training new team members and acting as a technical resource for less experienced claims representatives.

  • Maintaining continuing education requirements.
  • Qualifications/Requirements


    Knowledge and Experience:

  • Active adjuster license required.

  • Minimum of 10 years of experience handling complex Workers’ Compensation claims.

  • Multi-state experience in jurisdictions such as California, Arizona, Colorado, Wyoming, Texas, and Oklahoma (willingness to learn additional jurisdictions is required).

  • Proficiency in structured settlements and Medicare Set-Asides.

  • Strong negotiation, analytical, organizational, and time management skills.

  • Ability to work independently in a fast-paced, virtual office environment.

  • Advanced verbal and written communication skills for interacting with internal and external stakeholders.

  • Proficiency in MS Word, Excel, and internet applications.

  • Highly detail-oriented with the ability to prioritize tasks effectively under pressure.
  • Education:

  • Bachelor’s degree required.

  • Industry designations such as AIC, SCLA, or CPCU are a plus.
  • Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.


    #LI-BC1


    Required Skill Profession

    Business Operations Specialists



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