• Expertini Resume Scoring: Our Semantic Matching Algorithm evaluates your CV/Résumé before you apply for this job role.
United States Jobs Expertini

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


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


    • Job Details

    Related Jobs

    The Jonus Group hiring Complex Claims Specialist - WC (East) Job in Omaha, Nebraska, United States
    The Jonus Group
    Omaha, Nebraska, United States
    Holman Enterprises, Inc. hiring Specialist - WC Claims Support Job in Mount Laurel, New Jersey, United States
    Holman Enterprises, Inc.
    Mount Laurel, New Jersey, United States
    Zurich Insurance Company hiring WC Senior Claims Specialist Job in Maitland, Florida, United States
    Zurich Insurance Company
    Maitland, Florida, United States
    Zurich NA hiring WC Senior Claims Specialist Job in Maitland, FL, United States
    Zurich NA
    Maitland, FL, United States
    Zurich NA hiring WC Senior Claims Specialist Job in Maitland, FL, United States
    Zurich NA
    Maitland, FL, United States
    Berkley hiring Complex Claims Specialist Job in Durham, North Carolina, United States
    Berkley
    Durham, North Carolina, United States
    The Jonus Group hiring WC Claims Adjuster Job in Salt Lake City, Utah, United States
    The Jonus Group
    Salt Lake City, Utah, United States
    CHUBB hiring ESIS Claims Representative, WC Job in Cheektowaga, New York, United States
    CHUBB
    Cheektowaga, New York, United States
    CHUBB hiring ESIS Claims Representative, WC Job in Phoenix, Arizona, United States
    CHUBB
    Phoenix, Arizona, United States
    Berkley hiring WC Claims Representative 1 Job in Greenwich, Connecticut, United States
    Berkley
    Greenwich, Connecticut, United States
    Adecco US, Inc. hiring Claims Examiner   WC  1451167 Job in Orange, CA, United States
    Adecco US, Inc.
    Orange, CA, United States
    Adecco US, Inc. hiring Claims Examiner   WC  1449986 Job in Los Angeles, CA, United States
    Adecco US, Inc.
    Los Angeles, CA, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in Naperville, Illinois, United States
    The Hartford
    Naperville, Illinois, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in Scottsdale, Arizona, United States
    The Hartford
    Scottsdale, Arizona, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in Hartford, CT, United States
    The Hartford
    Hartford, CT, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in , SAN ANTONIO - WISEMAN BLVD, United States
    The Hartford
    , SAN ANTONIO - WISEMAN BLVD, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in , UNITED STATES - REMOTE, United States
    The Hartford
    , UNITED STATES - REMOTE, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in Scottsdale, AZ, United States
    The Hartford
    Scottsdale, AZ, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in Naperville, IL, United States
    The Hartford
    Naperville, IL, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in Scottsdale, AZ, United States
    The Hartford
    Scottsdale, AZ, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in Naperville, IL, United States
    The Hartford
    Naperville, IL, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in , UNITED STATES - REMOTE, United States
    The Hartford
    , UNITED STATES - REMOTE, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in , SAN ANTONIO - WISEMAN BLVD, United States
    The Hartford
    , SAN ANTONIO - WISEMAN BLVD, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in Hartford, CT, United States
    The Hartford
    Hartford, CT, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in , LAKE MARY - COLONIAL CENTER PKWY, United States
    The Hartford
    , LAKE MARY - COLONIAL CENTER PKWY, United States
    The Hartford hiring Claim Specialist - Complex Claims Unit Job in , LAKE MARY - COLONIAL CENTER PKWY, United States
    The Hartford
    , LAKE MARY - COLONIAL CENTER PKWY, United States
    AIG hiring Complex Claims Director Job in Atlanta, Georgia, United States
    AIG
    Atlanta, Georgia, United States
    CRC Insurance Services, Inc. hiring Complex Claims Adjuster Job in Flower Mound, TX, United States
    CRC Insurance Services, Inc.
    Flower Mound, TX, United States
    Sedgwick hiring Complex Claims Advisor Job in Sun Prairie, WI, United States
    Sedgwick
    Sun Prairie, WI, United States
    Sedgwick hiring Complex Claims Analyst Job in Chicago, IL, United States
    Sedgwick
    Chicago, IL, United States
    Sedgwick hiring Complex Claims Analyst Job in Moline, IL, United States
    Sedgwick
    Moline, IL, United States

    Unlock Your Complex Claims Potential: Insight & Career Growth Guide


    Real-time Complex Claims Jobs Trends (Graphical Representation)

    Explore profound insights with Expertini's real-time, in-depth analysis, showcased through the graph here. Uncover the dynamic job market trends for Complex Claims in Omaha, United States, highlighting market share and opportunities for professionals in Complex Claims roles.

    8370 Jobs in United States
    8370
    42 Jobs in Omaha
    42
    Download Complex Claims Jobs Trends in Omaha and United States

    Are You Looking for Complex Claims Specialist WC (WEST) Job?

    Great news! is currently hiring and seeking a Complex Claims Specialist WC (WEST) to join their team. Feel free to download the job details.

    Wait no longer! Are you also interested in exploring similar jobs? Search now: .

    The Work Culture

    An organization's rules and standards set how people should be treated in the office and how different situations should be handled. The work culture at The Jonus Group adheres to the cultural norms as outlined by Expertini.

    The fundamental ethical values are:

    1. Independence

    2. Loyalty

    3. Impartiapty

    4. Integrity

    5. Accountabipty

    6. Respect for human rights

    7. Obeying United States laws and regulations

    What Is the Average Salary Range for Complex Claims Specialist WC (WEST) Positions?

    The average salary range for a varies, but the pay scale is rated "Standard" in Omaha. Salary levels may vary depending on your industry, experience, and skills. It's essential to research and negotiate effectively. We advise reading the full job specification before proceeding with the application to understand the salary package.

    What Are the Key Qualifications for Complex Claims Specialist WC (WEST)?

    Key qualifications for Complex Claims Specialist WC (WEST) typically include Business Operations Specialists and a list of qualifications and expertise as mentioned in the job specification. The generic skills are mostly outlined by the . Be sure to check the specific job listing for detailed requirements and qualifications.

    How Can I Improve My Chances of Getting Hired for Complex Claims Specialist WC (WEST)?

    To improve your chances of getting hired for Complex Claims Specialist WC (WEST), consider enhancing your skills. Check your CV/Résumé Score with our free Tool. We have an in-built Resume Scoring tool that gives you the matching score for each job based on your CV/Résumé once it is uploaded. This can help you align your CV/Résumé according to the job requirements and enhance your skills if needed.

    Interview Tips for Complex Claims Specialist WC (WEST) Job Success

    The Jonus Group interview tips for Complex Claims Specialist   WC (WEST)

    Here are some tips to help you prepare for and ace your Complex Claims Specialist WC (WEST) job interview:

    Before the Interview:

    Research: Learn about the The Jonus Group's mission, values, products, and the specific job requirements and get further information about

    Other Openings

    Practice: Prepare answers to common interview questions and rehearse using the STAR method (Situation, Task, Action, Result) to showcase your skills and experiences.

    Dress Professionally: Choose attire appropriate for the company culture.

    Prepare Questions: Show your interest by having thoughtful questions for the interviewer.

    Plan Your Commute: Allow ample time to arrive on time and avoid feeling rushed.

    During the Interview:

    Be Punctual: Arrive on time to demonstrate professionalism and respect.

    Make a Great First Impression: Greet the interviewer with a handshake, smile, and eye contact.

    Confidence and Enthusiasm: Project a positive attitude and show your genuine interest in the opportunity.

    Answer Thoughtfully: Listen carefully, take a moment to formulate clear and concise responses. Highlight relevant skills and experiences using the STAR method.

    Ask Prepared Questions: Demonstrate curiosity and engagement with the role and company.

    Follow Up: Send a thank-you email to the interviewer within 24 hours.

    Additional Tips:

    Be Yourself: Let your personality shine through while maintaining professionalism.

    Be Honest: Don't exaggerate your skills or experience.

    Be Positive: Focus on your strengths and accomplishments.

    Body Language: Maintain good posture, avoid fidgeting, and make eye contact.

    Turn Off Phone: Avoid distractions during the interview.

    Final Thought:

    To prepare for your Complex Claims Specialist WC (WEST) interview at The Jonus Group, research the company, understand the job requirements, and practice common interview questions.

    Highlight your leadership skills, achievements, and strategic thinking abilities. Be prepared to discuss your experience with HR, including your approach to meeting targets as a team player. Additionally, review the The Jonus Group's products or services and be prepared to discuss how you can contribute to their success.

    By following these tips, you can increase your chances of making a positive impression and landing the job!

    How to Set Up Job Alerts for Complex Claims Specialist WC (WEST) Positions

    Setting up job alerts for Complex Claims Specialist WC (WEST) is easy with United States Jobs Expertini. Simply visit our job alerts page here, enter your preferred job title and location, and choose how often you want to receive notifications. You'll get the latest job openings sent directly to your email for FREE!