Workers Compensation and Risk
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Overview
Job Description
JOB SUMMARY
The Workers’ Compensation and Risk Specialist III is responsible for managing complex workers’ compensation claims and serving as a subject matter expert for the organization’s workers’ compensation program. This role leads high-exposure claim strategies, partners cross-functionally to reduce risk, and drives continuous improvement in claim outcomes, cost containment, and employee experience. The Specialist III also plays a key role in enterprise risk management initiatives and mentors junior team members.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Claims Management & Strategic Oversight
• Manage the full lifecycle of workers’ compensation claims, including complex, high-exposure, litigated, and multi-jurisdictional cases
• Serve as escalation point for challenging claims, providing guidance on compensability, reserves, and settlement strategy
• Develop and implement claim strategies to optimize outcomes, minimize risk exposure, and control total cost of risk
• Lead regular claim reviews with TPAs, carriers, and internal stakeholders to ensure proactive claim handling
• Establish appropriate reserves and approve settlements within expanded authority guidelines
• Identify trends, root causes, and opportunities for systemic improvements in claim handling
Business Partnership & Program Leadership
• Act as a trusted advisor to HR, Operations, Safety, and Leadership on workers’ compensation matters
• Partner with safety teams to identify injury trends and implement prevention strategies
• Lead return-to-work program effectiveness, including modified duty strategy and vendor optimization
• Ensure compliance with all state workers’ compensation laws and OSHA requirements
• Provide guidance during audits, litigation, and regulatory inquiries
Risk Management & Continuous Improvement
• Support and influence enterprise risk management initiatives related to occupational risk
• Analyze claim data and produce insights to inform leadership decision-making
• Recommend process improvements, automation opportunities, and policy enhancements
• Participate in insurance renewal strategy, including providing loss data analysis and insights
Mentorship and Leadership
• Mentor and provide guidance to Specialist I and II roles
• Support onboarding and training of new team members
• Lead or contribute to cross-functional projects and initiatives
JOB QUALIFICATIONS: Education & Experience Requirements
Skills and Competencies
• Advanced knowledge of workers’ compensation laws, claims handling, and injury management
• Strong analytical and problem-solving skills with ability to interpret complex data
• Demonstrated negotiation and influencing skills in high-stakes situations
• Ability to manage ambiguity and lead through complex claim scenarios
• Strong communication and stakeholder management skills
• Advanced proficiency in claims systems, RMIS, and Microsoft Office tools
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EDUCATION & EXPERIENCE
• Bachelor’s degree orequivalent experience required
• 5–8 years of workers’ compensation or risk management experience required
• Professional certification, in at least one State (e.g., CPCU, ARM, AIC, or Workers’ Compensation certification) required
• Experience handling high-volume and high-complexity claims environments required
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