Bilingual Customer Service Representative - Workers Compensation Claims

About the role

This role supports a global insurance client by handling workers compensation claims and providing empathetic customer service in a hybrid work model. The specialist reviews claim details, updates records and communicates with claimants and internal teams in Spanish and English, focusing on accurate claim handling, timely resolution and a positive service experience.

Key responsibilities

• Handle end-to-end workers compensation claims by gathering details, validating coverage and documenting every interaction.
• Listen to injured workers, employers and medical providers and explain claims clearly to reduce stress and confusion.
• Review claim documents, medical reports and wage information to determine compensability and benefits while complying with company policies and regulations.
• Coordinate with claims examiners, nurses and legal specialists to support fair claim decisions.
• Update claim management systems with notes, payment information and status changes.
• Communicate with customers by phone, email and chat in Spanish and English about claim status, payment schedules, documentation and coverage.
• Escalate issues such as missing documents, conflicting statements or unusual patterns to specialists.
• Follow SOPs, quality guidelines and SLAs, share improvement ideas and respect confidentiality and data privacy.
• Work in a hybrid model, manage time between remote and office tasks and cover rotational shifts.

Required profile

• Proven customer service experience handling complex inquiries.
• Working knowledge of workers compensation claims processes (intake, investigation, benefit calculation, ongoing maintenance).
• Strong Spanish reading, writing and speaking skills.
• Familiarity with insurance or claims administration environments and regulatory expectations.
• Flexibility to work rotational shifts in a hybrid model.
• Preferred: customer service or insurance claims certification such as AIC or similar.