Pay Range: $45hr - $50hr
- Responsible for analyzing, investigating, and managing complex workers' compensation claims through resolution.
- Handles claim exposure assessment, reserve management, litigation coordination, and benefit administration while ensuring compliance with applicable insurance laws and regulations.
- Collaborates with claimants, clients, vendors, and legal partners to deliver timely and cost-effective claim resolutions.
Requirement/Must Have:
- Strong experience managing workers' compensation claims.
- Knowledge of insurance principles, laws, and regulations related to workers' compensation claims.
- Experience handling claim investigations, litigation management, and settlement negotiations.
- Strong analytical and organizational skills.
- Excellent oral and written communication skills.
- Strong negotiation and interpersonal skills.
- Proficiency with Microsoft Office products and PC applications.
- Ability to work effectively in a team environment.
- Ability to meet or exceed service expectations.
Experience:
- Five years of claims management experience or equivalent combination of education and experience required.
- Experience managing claim reserves, recoveries, and benefit calculations.
- Experience coordinating with vendors, legal teams, and excess carriers.
- Experience handling Social Security and Medicare offsets preferred.
Responsibilities:
- Analyze and process complex workers' compensation claims.
- Investigate claims and gather information to determine claim exposure.
- Develop and manage claim action plans through resolution.
- Negotiate settlements within designated authority levels.
- Calculate and assign claim reserves and manage reserve adequacy.
- Calculate and process benefit payments and claim adjustments.
- Prepare and submit required state filings within statutory deadlines.
- Manage litigation activities and coordinate cost-effective claim resolution strategies.
- Coordinate vendor referrals for investigations and litigation support.
- Utilize cost containment and medical management practices to reduce claim costs.
- Manage claim recoveries including subrogation and offsets.
- Report claims to excess carriers and respond to requests in a timely manner.
- Communicate claim activity and updates with claimants and clients.
- Maintain accurate claim documentation and coding.
- Refer complex cases to supervisors and management when appropriate.
- Support organizational quality programs and additional assigned duties.
- Travel as required.
Should Have:
- Professional certification related to claims or insurance preferred.
- Experience with Social Security and Medicare application procedures preferred.
- Knowledge of disability duration and medical management practices preferred.
Skills:
- Workers' compensation claims management.
- Litigation and settlement negotiation.
- Reserve management and cost containment.
- Claim investigation and analysis.
- Insurance laws and compliance.
- Communication and client relationship management.
- Documentation and reporting.
- Microsoft Office proficiency.
- Problem-solving and organizational skills.
Qualification And Education:
- Bachelor’s degree from an accredited college or university preferred.
- Professional certification related to line of business preferred.
Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading staffing and recruiting powerhouse. Proudly recognized as a nationally and locally certified diversity firm, Cynet delivers agile, scalable talent solutions across industries. With an active footprint in all 50 U.S. states and Canada, we support thousands of consultants through our expansive, high-performing recruitment engine operating across North America and Asia—ensuring speed, quality, and consistency in every hire.