Hybrid Customer Service Specialist

About the role

This hybrid position focuses on workers‑compensation insurance claims while delivering high‑quality customer service. You will manage claims from initial notification through closure, collaborating with internal teams and external partners to ensure fair and timely outcomes.

Key responsibilities

• Manage workers‑compensation claims end‑to‑end, ensuring accurate documentation and timely resolution.
• Coordinate with policyholders, claimants, medical providers, and internal teams to gather information and clarify claim details.
• Evaluate claim information, coverage terms, and supporting documents to determine compensability and appropriate handling strategies.
• Document all claim activities, conversations, and decisions in the claim management system with high accuracy.
• Communicate claim status, next steps, and timelines to customers and stakeholders with empathy and clarity.
• Collaborate with medical case managers and external partners on treatment plans, return‑to‑work options, and associated costs.
• Analyze claim trends and payment patterns to identify process‑improvement opportunities.
• Adhere to workers‑compensation regulations and internal compliance guidelines.
• Respond promptly to customer inquiries via phone, email, or digital channels while maintaining professionalism.
• Utilize claim‑management tools and reporting dashboards to track workload, prioritize tasks, and meet service‑level agreements.
• Support rotational shift coverage and ensure seamless handover of pending claims.
• Participate in team meetings, calibration sessions, and knowledge‑sharing forums.
• Contribute feedback for continuous‑improvement initiatives.

Required profile

• 2–3 years of hands‑on experience handling workers‑compensation insurance claims.
• Strong customer‑service skills, including active listening and the ability to manage difficult conversations with empathy.
• Sound understanding of workers‑compensation principles and relevant regulations.
• Excellent written and verbal communication skills.
• Ability to work flexible hours and support rotational shift coverage.

Required skills