Workers' Compensation Claims Representative III

Dayforce

Claims Representative responsible for managing complex workers' compensation claims involving high financial exposure. Overseeing advanced medical case management and collaborating with vocational consultants and legal counsel.

Posted 7/29/2026full-timeSt. Louis • Illinois, Iowa, Kansas, Montana, New York, Tennessee • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing complex Workers' Compensation claims, including advanced medical case management, fraud investigation, and compliance with state statutes. Proficient in developing Return-to-Work plans and collaborating with legal counsel and external vendors.

Highest-signal resume keywords

Workers' Compensation Claims ManagementAdvanced Medical Case ManagementFraud InvestigationReturn-to-Work Plan DevelopmentClaims Handling Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims HandlingCoverage InvestigationSettlement NegotiationDocumentation ComplianceClaim Reserve Management

Soft Skills

MentorshipCollaborationCommunication

Tools & Technologies

Claims Management Systems

Certifications & Qualifications

Associate in Claims (AIC)Texas-All Lines License

Industry Keywords

Workers' CompensationMedical Case ManagementFraud DetectionSubrogationLitigation Management

About the role

Key responsibilities & impact

Manage complex workers’ compensation claims involving high financial exposure, sensitive issues, or extended life cycles.
Investigate coverage and compensability, ensuring thorough documentation and compliance with state statutes.
Oversee advanced medical case management, including coordination with Nurse Case Managers and external vendors.
Develop and implement Return-to-Work plans for high-risk claims, collaborating with vocational consultants and legal counsel.
Identify and investigate potential fraud and subrogation opportunities, partnering with the Special Investigation Unit.
Establish and maintain accurate claim reserves within authority levels, ensuring timely responsiveness to changing circumstances.
Evaluate and negotiate settlements within approved authority levels, including structured settlements and Medicare compliance.
Collaborate with legal counsel to manage litigation and ensure adherence to MEM guidelines.
Maintain accurate system data and prepare reports for management on high-profile claims.
Foster cross-departmental collaboration with Underwriting, Premium Consultation, and Loss Prevention.
Provide mentorship and training to junior adjusters, supporting professional growth and team development.

Requirements

What you’ll need

High school diploma or equivalent required; bachelor’s degree preferred.
Associate in Claims (AIC) designation preferred.
Valid driver’s license required; Texas-All Lines license preferred.
3–5 years of claims handling experience, primarily in Workers’ Compensation. Missouri experience preferred.

Benefits

Comp & perks

Health Plans: Medical, Dental, and VisionIncludes fertility benefits, fully paid preventative care, and adult orthodontia.
Employer-Paid Life and Disability Benefits:Life Insurance (3x base salary), AD&D, Short and Long-term Disability.
Wellness and Recognition Program: Employer-paid incentives for employees and spouses.
Flexible Spending Account and Dependent Care options
Health Savings Account: Generous employer contribution.
Time Away from Work:Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave.
Employee Assistance Programs
401k Retirement Plan: Employer match and profit sharing.
Adoption Assistance and Tuition Assistance