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Claims Specialist

Summary:

The Claims Specialist is responsible for administering workers’ compensation claims to ensure timely reporting, proper documentation, and compliance with applicable regulations. This role supports claim investigations, monitors claim progress, coordinates return-to-work programs, and serves as a liaison between employees, management, insurance carriers, and other stakeholders. The ideal candidate is detail-oriented, organized, and able to handle sensitive information while ensuring efficient claims administration.

Responsibilities:

Receive and review First Report of Injury forms for accuracy and completeness.
Report workplace injuries to insurance carriers or Third-Party Administrators (TPAs) within required timelines.
Verify employee eligibility and employment status at the time of injury.
Conduct initial claim investigations, including interviews with employees, supervisors, and witnesses.
Collect and maintain documentation such as incident reports, job descriptions, and wage statements.
Maintain accurate electronic and physical claim files in compliance with record retention requirements.
Monitor claim progress including medical treatment, lost time, work restrictions, and return-to-work status.
Assess compensability concerns, communicate findings to adjusters, and review adjuster notes and reserve amounts regularly.
Coordinate return-to-work and modified duty assignments based on medical restrictions and track assignment duration.
Communicate claim updates and return-to-work expectations with employees and supervisors.
Coordinate with legal counsel on litigated claims and assist with subpoenas or discovery requests.
Monitor claim trends, participate in claim review meetings with carriers and TPAs, and support injury prevention efforts.
Maintain workers’ compensation claim records and databases, including claim status and closure data, while ensuring compliance with record retention requirements.
Securely manage confidential medical documentation in accordance with HIPAA and privacy regulations and audit files periodically to ensure documentation accuracy and completeness.
Prepare and maintain OSHA 300, 300A, and 301 logs and submit required state injury reports and workers’ compensation filings.
Coordinate with payroll for wage statements and indemnity calculations when required.
Serve as liaison between employees, supervisors, HR, payroll, insurance carriers, medical providers, and legal counsel.
Communicate claim status updates to leadership, address employee questions regarding benefits and claim procedures, and coordinate claim review meetings with insurance representatives.
Maintain and update workers’ compensation policies and procedures, develop internal claim reporting guidelines, and assist in training supervisors on injury reporting protocols.
Perform other duties as assigned by management.

Important Notice: This job description is not an exclusive or exhaustive list of all job functions that a team member in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced or delegated by management to meet business needs of the company.

Qualifications:

A Bachelor’s degree in Human Resources, Risk Management, Business Administration, or a related field is preferred. Relevant experience may be considered in lieu of education.
3 - 4 years of experience in workers’ compensation, claims administration, risk management, or a related field. Experience in retail, manufacturing, or logistics environments is preferred.
Bilingual in English/Mandarin or English/Spanish is required.
Knowledge of workers’ compensation laws, OSHA regulations, and state injury reporting requirements.
Experience working with insurance carriers, Third-Party Administrators (TPAs), and claims adjusters.
Strong analytical, organizational, and problem-solving skills with the ability to manage multiple claims simultaneously.
Excellent written and verbal communication skills with the ability to interact across all levels of the organization.
Ability to handle confidential medical and employee information with discretion and professionalism.
Proficiency in Microsoft Office Suite (Excel, Word, Outlook); experience with claims management systems or HRIS platforms is a plus.
Detail-oriented, proactive, and able to multitask in a fast-paced environment.
Authorized to work in the United States without sponsorship.

Physical Requirements:

Prolonged periods sitting at a desk and working on a computer.
This job may require standing or walking for extended periods of time, lifting up to 50 pounds, and performing repetitive motions.

Position Details:

Employment Type: Full Time.
Location: 6338 Regio Ave, Buena Park, CA 90620.
Available to work on weekends and holidays as necessary.

Benefits:

Medical, Dental, Vision, and Life Insurance.
401 (k) Retirement Saving Plan with 4% Company Match.
Long-Term Services Award.
Employee Discount.
Paid Time Off.

Compensation:

The pay range for this job starts at $75,000 - $80,000 per year. This is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) the responsibilities of the job, your education, skills, qualifications, experience, and location.

Beware of Job Scams:

We prioritize applicant safety at TAWA Services, Inc. Please exercise caution during your job search. Be wary of unsolicited offers, requests for personal information or upfront payments, poorly written job descriptions, unrealistic promises, and unprofessional communication. Research employers, verify job postings, and trust your instincts. Report any suspicious activity. For helpful guidance on identifying job scams, visit this link provided by the Indeed website: https://www.indeed.com/career-advice/finding-a-job/job-scams

Disclaimer:

Our goal is to be a recognized leader in the industry while providing a great workplace for employees. Please note the job descriptions are intended to describe the general nature and level of work being performed by people assigned to the position. They do not cover all the details of skills, duties, or responsibilities required for the positions. Thus, they are not to be construed as an exhaustive list of all skills, duties, and responsibilities required for personnel. All personnel may be required to perform duties outside of their normal responsibilities as instructed by management. Skills, duties and responsibilities may change at any time with or without notice. We are an E.E.O. employer.

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