Senior Claims Representative (Remote)

1. About Our Client: The organization operates within the insurance industry, specializing in workers' compensation claims. It addresses the challenges of managing complex, high-exposure claims involving legal and medical intricacies. The company focuses on delivering thorough claims handling, fraud investigations, and strategic risk management to support injured workers and policyholders.2. About the Opportunity: The Senior Claims Representative is responsible for managing complex workers' compensation claims with significant financial exposure. This role involves leading investigations, overseeing medical case management, developing return-to-work strategies, and collaborating across departments to improve claims processes. The position contributes to the organization's effectiveness by ensuring regulatory compliance, guiding high-stakes negotiations, and mentoring junior staff.3. Responsibilities:Manage complex claims with significant financial and legal factors.Conduct in-depth investigations into coverage, compensability, and fraud.Oversee medical case management for catastrophic injuries.Review and negotiate large or complex medical bills.Develop and implement return-to-work strategies.Ensure accurate benefit calculations and compliance.Lead subrogation efforts and negotiate recoveries.Partner with legal teams on settlements and litigation.Oversee Medicare compliance and structured settlement negotiations.Prepare strategic reports for management decision-making.Maintain data integrity and prepare claims for corporate review.Lead cross-departmental initiatives for claims and risk management.Resolve escalated customer service issues.Mentor and coach junior and intermediate adjusters.Support workforce development and succession planning.4. Requirements:Bachelor’s degree in business or related field preferred, or equivalent experience.7–10 years of workers’ compensation claims experience.Preferred: Associate in Claims (AIC), AIM, or CPCU designation or ability to obtain.Preferred: Texas All-Lines license.Valid driver’s license.5. Pay Range and Compensation Package:The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.6. Benefits & Perks:Medical, dental, and vision plans including fertility benefits and adult orthodontia.Employer-paid life insurance and short and long-term disability.Wellness and recognition programs with employer-paid incentives.Flexible Spending Account and Dependent Careoptions.Health Savings Account with generous employer contribution.Paid time off including PTO, holidays, volunteer time, parental leave, and other leaves.Employee assistanceprograms.401(k) retirement plan with employer match and profitsharing.Adoption and tuition assistance.7. Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.Note: RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.