Claims Specialist
HSM Worx Inc.
About the role
The Workers Compensation claims specialist will oversee end-to-end workplace injury claims for our client, a USA based Skilled Nursing Group. From first report through claim closure, this role serves as the primary liaison between injured employees, HR, and the insurance carrier's claims adjusters, ensuring injured workers receive timely medical care while managing claim costs and reserves on behalf of the company.
This is an on-site graveyard shift role so that you can reach adjusters, carriers, and client HR during U.S. business hours.
What You’ll Do
• Manage a caseload of open workers’ compensation claims from first report through closure.
• Report new claims to the insurance carrier and confirm each one is set up correctly.
• Serve as the point of contact for injured employees, keeping them informed and confirming they are receiving appropriate medical care.
• Work with claims adjusters to monitor status, clear outstanding items, and drive claims toward timely closure.
• Review claim reserves for accuracy and raise exposure that does not match the facts of the claim.
• Maintain complete, audit-ready documentation for every claim in the claims management system.
• Escalate claims trending toward litigation, extended lost time, or unusual cost.
• Coordinate with HR on return-to-work timing and documentation.
• Report on claim volume, status, and aging to HSM Worx and client leadership.
Requirements
• 2 to 4 years in workers’ compensation claims administration, risk management, or a related field.
• Working knowledge of U.S. workers’ compensation processes, medical treatment protocols, and claims/reserve management.
• Strong spoken and written English, with the ability to interact professionally with employees, HR staff, and insurance carrier representatives.
• Highly organized, with strong follow-through and attention to detail.
• Ability to manage multiple open claims simultaneously and prioritize effectively.
• Availability to work the graveyard shift on-site in our Alabang office.
About us
The company is a growing U.S.-based healthcare services company with a significant operational presence in the Philippines. The Philippine organization currently has approximately 50 employees and has become a core part of the company's business. The team originally operated as a back-office support function but has since evolved into a broader healthcare services operation supporting companies across the United States.
The organization's largest service offering is healthcare recruiting. The Philippine team supports U.S. healthcare organizations by recruiting healthcare professionals. In addition to recruiting, the organization supports a variety of other healthcare-related functions, including healthcare insurance operations, call center functions, scheduling, administrative support, and other client-specific operational services.
The business effectively operates as a specialized healthcare services and BPO organization, providing dedicated teams and operational support to healthcare companies across the United States.
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