Associated Designations
CWCP — Certified Workers Compensation ProfessionalWorkers Compensation Claims Specialist
Workers Compensation Claims Specialists investigate, evaluate, and resolve work‑related injury claims.
They determine compensability, coordinate medical treatment, manage disability benefits, and ensure compliance
with state Workers Compensation laws. This role is central to controlling claim costs and supporting injured employees.
📘 Role Overview
WC Claims Specialists handle a portfolio of Workers Compensation claims from first notice of loss through closure.
They assess injury details, gather statements, review medical documentation, set reserves, and collaborate with
employers, medical providers, attorneys, and TPAs. The role requires strong analytical judgment, communication skills,
and knowledge of jurisdictional rules.
🛠️ Key Responsibilities
- Investigate work‑related injuries and determine compensability
- Coordinate medical treatment and monitor provider progress
- Manage wage‑replacement benefits and disability status
- Set and adjust claim reserves based on exposure
- Communicate with employers, injured workers, and medical professionals
- Identify potential fraud and coordinate SIU referrals
- Manage litigated claims in partnership with defense counsel
- Ensure compliance with state reporting and regulatory requirements
- Document claim activity and maintain accurate claim files
🧠 Skills & Competencies
- Knowledge of Workers Compensation statutes and jurisdictional rules
- Medical terminology and treatment plan familiarity
- Strong communication and negotiation skills
- Analytical judgment and reserve accuracy
- Time management and caseload organization
- Ability to manage sensitive conversations with injured workers
🎓 Typical Background
- Experience as a claims adjuster, examiner, or assistant
- Knowledge of WC systems, medical billing, or disability management
- Familiarity with TPAs, carriers, or self‑insured programs
