Senior Workers Compensation Specialist I

Surge Staffing•Columbus, OH

1d•$60,000 - $65,000

About The Position

The Senior Workers’ Compensation Specialist I is responsible for managing low level and escalated workers’ compensation claims and serves as a senior technical resource within the Workers’ Compensation department. This role builds upon the early-claims ownership by taking ownership of claims that extend beyond the initial lifecycle or present increased complexity, including prolonged medical treatment, lost-time exposure, or elevated risk factors.

Requirements

High school diploma or equivalent
5+ years of workers’ compensation or claims management experience
Experience managing complex or escalated claims, including extended or high-risk cases
Strong understanding of claim lifecycle, medical management, and return-to-work practices
Ability to analyze claim trends, identify risk factors, and make informed decisions
Demonstrated ability to mentor or support junior team members

Nice To Haves

Bachelor’s degree in Business, Risk Management, HR, or related field
Professional certifications (e.g., AIC, WCCP, ARM, or similar)
Experience working with litigated claims or complex medical cases
Experience participating in claim review meetings or strategy discussions
Advanced knowledge of OSHA and regulatory compliance

Responsibilities

Own and manage medical workers’ compensation claims, including those extending beyond 90 days or involving increased exposure
Monitor claim progression and make day-to-day claim handling decisions based on medical status, return-to-work potential, and risk factors
Identify trends, red flags, and escalation triggers that may impact claim duration or cost
Ensure appropriate claim strategy is executed in alignment with internal standards and external partners
Review escalated claims from the Workers’ Compensation Specialist II and assume ownership of ongoing management
Determine appropriate next steps for complex claims, including medical management, return-to-work planning, and escalation pathways
Partner with leadership on high-risk or sensitive claims as needed
Serve as a primary point of contact for complex claims with Third-Party Administrators (TPAs), adjusters, and Nurse Case Managers
Coordinate claim strategy, medical treatment plans, and return-to-work opportunities
Ensure timely and accurate communication between internal stakeholders and external partners
Oversee return-to-work strategies for complex or extended claims
Provide guidance on complex work restrictions and accommodations
Support implementation of process improvements to enhance efficiency and claim outcomes
This position requires participation in an on-call rotation. Employees must be available to respond to work-related calls, messages, or emergencies outside of regularly scheduled working hours as assigned. The employee is expected to maintain reliable communication access and be able to report to work or perform duties remotely within a reasonable response time when on call.
Complies with all applicable federal, state, and local laws, regulations, and company policies
Performs other duties as assigned to support departmental and organizational objectives.