The Workers' Compensation Claims Specialist is responsible for the accurate and timely preparation, review, and submission of wage statement forms and supporting documentation for workers' compensation claims. This role analyzes payroll records, timesheets, earnings data, and related documentation to support claim administration while ensuring compliance with applicable laws, regulations, and company policies.
In addition to wage statement preparation, this position supports the overall Workers' Compensation program by coordinating claim activity, maintaining claim records, assisting with return-to-work and accommodation efforts, and serving as a liaison between Human Resources, Payroll, insurance carriers, third-party administrators, state workers' compensation boards, and other stakeholders.
Essential Responsibilities
- Compile, review, and analyze payroll records, timesheets, bonuses, and wage information for workers' compensation claims.
- Prepare and submit required Workers' Compensation Wage Statement Forms, including state-specific forms such as California DWC-12, Texas TWCC-3, and equivalent forms within required deadlines.
- Review payroll and claim data for accuracy and resolve wage discrepancies, missing hours, concurrent employment earnings, and other compensation-related issues.
- Serve as a resource for workers' compensation wage and payroll information for internal and external stakeholders.
- Coordinate claim activity, including claim intake, submission, follow-up, and maintenance of claim data within the Risk Management Information System (RMIS).
- Review open claim reports and identify claims that may be eligible for closure.
- Maintain accurate electronic claim files, correspondence, reports, and documentation in accordance with record retention requirements.
- Generate claim reports and provide status updates to Workers' Compensation leadership.
- Respond to workers' compensation inquiries, concerns, and claim-related issues while assisting employees in understanding available benefits.
- Partner with employees, managers, HR, Payroll, insurance carriers, claims administrators, healthcare providers, legal representatives, and other stakeholders to support claims management.
- Assist with return-to-work, rehabilitation, and workplace accommodation processes for employees recovering from occupational injuries or illnesses.
- Attend workers' compensation hearings and coordinate subrogation activities when applicable.
- Support administration of Ohio Bureau of Workers' Compensation (BWC) requirements and related programs.
- Coordinate required reporting of workplace injuries and illnesses to governmental agencies.
- Authorize payments related to medical bills and disability compensation within established authority levels.
- Review legal documents and coordinate with claims administrators and legal counsel as needed.
- Assist in developing and improving workers' compensation policies, procedures, goals, and best practices.
- Stay informed of workers' compensation trends, regulations, and legislative developments.
- Participate in special projects and cross-functional initiatives as assigned.
Qualifications
Education & Experience
- Bachelor's degree strongly preferred.
- Minimum of 5 years of experience in workers' compensation, claims administration, risk management, payroll, or a related field preferred.
- Professional certifications such as CPCU, ARM, AIC, WCCA, RIMS-CRMP, or similar are highly preferred.
- Commitment to ongoing professional development and industry learning preferred.
Knowledge, Skills & Abilities
- Strong understanding of workers' compensation claims administration and wage documentation requirements.
- Knowledge of applicable federal, state, and local workers' compensation laws and regulations.
- Familiarity with ADA, OSHA, reporting requirements, and employment-related regulations.
- Strong analytical, organizational, problem-solving, and decision-making skills.
- Excellent verbal and written communication skills.
- Ability to manage multiple priorities while maintaining accuracy and attention to detail.
- Experience working with confidential and sensitive information.
Technology Skills
- Proficiency in Microsoft Office Suite, including Excel, Word, PowerPoint, Teams, and web-based systems.
- Advanced Excel skills, including formulas, filtering, lookups, and data analysis, preferred.
- Experience with Risk Management Information Systems (RMIS) preferred.
Physical Requirements
- Ability to work for extended periods using standard office equipment and computers.
- Occasional lifting and handling of office materials and supplies.
- Travel may be required up to 10%.
Work Environment
Work location and onsite attendance requirements will be determined based on business needs and company practices.
Five Guys is an Equal Opportunity Employer and is committed to creating an inclusive workplace for all employees.