As a Claims Technical Specialist, you will serve as a trusted technical expert and strategic partner to the Claims organization, providing advanced guidance on complex workers' compensation claims, ensuring compliance with multi-jurisdictional regulatory and reporting requirements, and supporting the integrity of claims financials and systems.
Requirements
- Serve as a technical resource for claims staff by providing expert guidance on claims management practices, financial reconciliation, and resolution of complex or high-exposure claims.
- Conduct technical claim reviews and audits to ensure compliance with federal, state, contractual, reinsurance, and reporting requirements, including prompt action standards and quality benchmarks.
- Oversee and support EDI, Medicare (CMS), NCCI, and reinsurance reporting, partnering closely with Information Services and Finance to resolve data, system, and financial issues.
- Collaborate with Information Services to analyze claims technology needs, test and implement system enhancements, and validate system changes to ensure data integrity.
- Support claims financial accuracy through audit assistance, reconciliation efforts, and collaboration on recoveries and accounting issues.
- Develop, document, and maintain claims procedures, best practices, and internal resources to promote consistency and operational excellence.
- Provide training, coaching, and mentoring to claims staff, and contribute to training development, delivery, and claims hiring processes.
- Monitor emerging legal, regulatory, and industry trends in workers' compensation and support readiness for expansion into new jurisdictions.
Benefits
- Comprehensive medical, dental, and vision coverage
- Flexible hybrid work environment
- 401(k) with both Traditional and Roth options + company match
- Contributions toward student loan repayment
- Generous PTO, 9 paid holidays, and paid parental leave
- Monthly home internet allowance
- Free life insurance, short-term & long-term disability coverage
- Incentive bonus opportunities
- Adoption financial assistance
- Pet insurance
- Annual company-wide volunteer day
- Discounts on gyms, fitness apps, and wellness programs
