Hybrid customer service specialist.

Job Summary

This hybrid role supports specialized insurance claims processing for workers compensation with a strong focus on customer service. The specialist will manage end to end claims activities collaborate with cross functional teams and ensure accurate and timely resolution.

Responsibilities

• Manage workers compensation insurance claims from first notification through closure ensuring accurate documentation and timely resolution to support fair outcomes for all parties involved.
• Coordinate closely with policyholders claimants medical providers and internal teams to gather required information and clarify claim details in a clear professional manner.
• Evaluate claim information coverage terms and supporting documents to determine compensability and appropriate claim handling strategies aligned with company policies and regulatory expectations.
• Document all claim activities conversations and decisions in the claim management system with high levels of accuracy to support transparent claim histories and audit readiness.
• Communicate claim status next steps and expected timelines to customers and stakeholders with empathy and clarity reinforcing confidence in the service provided.
• Collaborate with medical case managers and external partners to review treatment plans return to work options and associated costs aiming to support worker recovery and cost effective outcomes.
• Analyze claim trends payment patterns and recurring issues to identify opportunities for process improvement and enhanced customer experience across the workers compensation portfolio.
• Adhere to all applicable workers compensation regulations and internal compliance guidelines ensuring consistent application of rules across all assigned claims.
• Respond promptly to customer service inquiries via phone email or digital channels resolving issues efficiently while maintaining a high standard of professionalism and courtesy.
• Utilize claim management tools and reporting dashboards to track workloads prioritize tasks and ensure service level agreements are consistently achieved.
• Support rotational shift coverage by maintaining flexibility in work hours and ensuring seamless handover of pending claims and tasks to colleagues for uninterrupted service.
• Participate in team meetings calibration sessions and knowledge sharing forums to stay updated on policy changes best practices and new product or process updates.
• Contribute to continuous improvement initiatives by sharing feedback from frontline claim handling experiences helping refine workflows and digital tools that benefit customers and society.

Qualifications

• Possess 2 to 3 years of hands on experience handling workers compensation insurance claims with direct responsibility for claim assessment documentation and resolution.
• Demonstrate strong customer service skills including active listening clear communication and the ability to manage difficult conversations with empathy and professionalism.
• Exhibit sound understanding of workers compensation principles claim lifecycle stages and typical roles of medical providers employers and regulators in the claim process.
• Show proficiency in using claim management systems and office productivity tools to record data prepare summaries and generate status updates for internal and external stakeholders.
• Apply basic analytical skills to interpret claim data identify inconsistencies and escalate potential risks or complex cases to senior claims professionals when needed.
• Display the ability to work effectively in a hybrid model environment balancing in office collaboration with remote work while maintaining productivity and service quality.
• Maintain adaptability for rotational shifts and demonstrate strong time management skills to handle multiple claims concurrently without