Senior Specialist, Claims

IPEX Group•Pineville, LA

1d•Hybrid

About The Position

The Senior Specialist, Claims is responsible for the end-to-end management of occupational injury, illness, disability, and related claims, ensuring compliance with Canadian and U.S. regulatory requirements. This includes assessing claim eligibility, managing reporting obligations, coordinating objections and appeals, supporting accommodation and return-to-work (RTW) programs, and representing the employer in claims-related proceedings when required. As a key liaison between employees, leaders, healthcare providers, insurers, and regulatory authorities, the role balances employee well-being with operational and financial objectives. This position contributes to reducing claim duration, supporting recovery outcomes, and strengthening claims and risk management practices. This is an individual contributor role with no direct people management responsibilities.

Requirements

Post-secondary education in Human Resources, Occupational Health, Nursing, Kinesiology, Business Administration, or a related field.
Bilingual in English and French.
3+ years of experience in occupational claims, disability/absence management, workers' compensation, or a related claims function within U.S. and/or Canadian jurisdictions.
Experience managing end-to-end claims processes, including eligibility assessment, regulatory reporting, case management, and cost monitoring.
Strong knowledge of workers' compensation legislation, human rights and accommodation requirements, privacy legislation, and occupational health and safety standards.
Excellent communication, collaboration, organization, problem-solving, and decision-making skills.
Strong attention to detail and ability to manage confidential information and records with accuracy.

Nice To Haves

Disability management or claims-related certification (e.g., CDMP) is an asset.
Experience with objections, appeals, cost relief applications, or administrative/legal review processes is an asset.

Responsibilities

Manage claims from first notice of loss through resolution, including occupational injury, disability, bodily injury, and property damage claims.
Assess claim eligibility and submit required reports to workers' compensation boards, insurers, and regulatory bodies.
Maintain accurate claim records, documentation, and data integrity.
Review and reconcile claim cost statements; investigate and resolve discrepancies.
Partner with operational leaders to support modified work, accommodations, and RTW plans.
Liaise with workers' compensation authorities, insurers, healthcare providers, and other external stakeholders.
Coordinate and participate in accommodation and RTW meetings to facilitate safe, timely employee reintegration.
Monitor legislative and regulatory changes across Canada and the U.S., providing guidance on reporting, accommodation, and claims management requirements.
Collaborate with internal legal teams and external counsel on complex claims, litigation, cost recovery, and settlements.
Serve as a primary contact for internal and external stakeholders, ensuring timely and effective communication.
Prepare regulatory submissions, objections, cost relief applications, internal reports, and executive summaries.
Represent the employer in appeals and administrative proceedings, as required.
Analyze claims data and trends to identify risk reduction and prevention opportunities.
Contribute to the continuous improvement of HSE, incident management, and claims processes.