Claims Technical Specialist

SFM - The Work Comp Experts•Bloomington, MN

28d•$90,141 - $126,198•Hybrid

About The Position

As a Claims Technical Specialist, you will serve as a trusted technical expert and strategic partner to the Claims organization. In this role, you’ll provide advanced guidance on complex workers’ compensation claims, ensure compliance with multi-jurisdictional regulatory and reporting requirements, and support the integrity of claims financials and systems. You’ll also play a key role in claims technology enhancements, audits, and training—helping drive consistency, quality, and continuous improvement across claims operations.

Requirements

Bachelor’s degree or an equivalent combination of education and relevant work experience
Seven or more years of experience handling workers’ compensation claims or similar roles in the property and casualty industry; multi jurisdictional experience preferred
Experience in technical claims support, compliance, auditing, financial reconciliation, claims systems analysis, or similar operational support functions preferred
Advanced knowledge of workers’ compensation claims handling and applicable laws and regulations
Strong analytical, research, and problem solving skills with the ability to interpret data and support sound decisions
Strong technical aptitude with claims systems, data, reporting tools, and Microsoft Office applications such as Excel and Word
Excellent verbal, written, and presentation skills with the ability to collaborate, coach, and support employee development
Ability to manage difficult conversations, maintain confidentiality, and exercise sound judgment and discretion
Highly organized with the ability to manage multiple priorities in a fast paced environment while maintaining strong customer service and partnership across teams
Ability to work onsite in the office when needed

Nice To Haves

Familiarity with IAIABC Claims EDI Reporting Standards preferred
Experience with reporting or analytics tools such as Cognos, Tableau, or Power BI preferred
Professional insurance designations related to area of expertise preferred

Responsibilities

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.