Note: The job is a remote job and is open to candidates in USA. POWERS Insurance and Risk Management is an insurance agency focused on delivering exceptional client service and supporting strong claims operations. The Claims Consultant will provide workers' compensation claims expertise through audits, regulatory guidance, training, process improvement, cross-functional collaboration, and accurate data reporting.
Responsibilities
- Conduct regular claims audits to promote consistent claim handling practices and adherence to agency standards, regulatory requirements, and industry best practices
- Analyze claim results, identify trends and opportunities for improvement, and communicate actionable recommendations to claims leadership
- Interpret workers' compensation laws, regulations, bulletins, and emerging legislative changes, providing practical guidance to claims teams and leadership
- Serve as a trusted resource on coverage interpretation, claims investigation best practices, regulatory compliance, and claims philosophy
- Create and maintain reference guides and educational resources that support ongoing professional development
- Partner with agency leadership to identify training opportunities and reinforce best practices through coaching and follow-up
- Collaborate with leadership and cross-functional teams to identify opportunities to improve claims processes, workflows, systems, and operational efficiency
- Participate in projects involving process improvements, vendor evaluations, and business initiatives
- Monitor industry trends and emerging best practices, recommending innovative solutions that strengthen our internal and claims operations
- Build strong partnerships across departments to ensure solutions meet business needs and enhance the client experience
- Research, analyze, and resolve Workers' Compensation data errors to ensure accurate and timely state reporting
- Reconcile reports and state acknowledgements to maintain data integrity
- Partner with claims professionals to ensure required data elements are captured and submitted accurately
- Foster a positive, collaborative, and professional work environment
- Maintain confidentiality and exercise sound judgment in all aspects of the role
- Travel occasionally for training, professional development, or business meetings as needed
- Perform other duties and special projects as assigned
Skills
- Bachelor's degree preferred, or an equivalent combination of education and relevant professional experience
- Three to five years of experience handling casualty and Workers' Compensation claims
- Strong knowledge of workers' compensation claims handling, coverage interpretation, and claims best practices
- Familiarity with medical cost containment practices, including experience working with ancillary programs such as physical therapy, diagnostics, and pharmacy
- Understanding of multi-state workers' compensation regulations and reporting requirements
- Excellent analytical, critical thinking, and problem-solving skills
- Strong written, verbal, and interpersonal communication skills
- Ability to build collaborative relationships across departments and influence positive outcomes
- Highly organized with the ability to manage multiple priorities independently
- Comfortable adapting to changing priorities while maintaining a high level of quality and accuracy
- Familiarity with IAIABC Claims standards and reporting guidelines
- Experience working with claims management systems and TPAs
- Experience participating in process improvement or operational excellence initiatives
Benefits
- Collaborative culture where your expertise is valued and your ideas are welcomed
- Professional growth is encouraged
- Your contributions are recognized
- Opportunities for career growth
Company Overview