Claims Technical Specialist

Claims Technical Specialist Bloomington, MN Job Details Full-time $90,141 - $126,198 a year 5 hours ago Benefits Internet reimbursement Paid parental leave Health savings account Paid holidays Loan repayment program Disability insurance Health insurance Dental insurance Flexible spending account Paid time off Parental leave Vision insurance Life insurance Pet insurance Qualifications Cognos Workers' compensation law Power BI 7 years Data visualization software proficiency Financial data reconciliation EDI Medicare Handling insurance claims Procedural guides Regulatory compliance in claims processing Data reporting Tableau Data quality management Hiring Analysis skills Policy & process development Bachelor's degree Continuous improvement Centers for Medicare and Medicaid Services (CMS) Accounting Mentoring Workers' compensation claims Productivity software Systems analysis Data analytics tools Senior level Regulatory audits Technical Proficiency Regulatory compliance management Training delivery Staff development

Full Job Description Location:

Bloomington, Minnesota (Hybrid - Approx. 1 day/week in office) |

Full-Time Pay:

$90,141 to $126,198 Ranked #8 Top Workplace - Midsize Employer, MN About the

Role:

As a Claims Technical Specialist , you will serve as a trusted technical expert and strategic partner to the Claims organization. In this role, you'll provide advanced guidance on complex workers' compensation claims, ensure compliance with multi-jurisdictional regulatory and reporting requirements, and support the integrity of claims financials and systems. You'll also play a key role in claims technology enhancements, audits, and training—helping drive consistency, quality, and continuous improvement across claims operations.

What You'll Do:

Serve as a technical resource for claims staff by providing expert guidance on claims management practices, financial reconciliation, and resolution of complex or high-exposure claims. Conduct technical claim reviews and audits to ensure compliance with federal, state, contractual, reinsurance, and reporting requirements, including prompt action standards and quality benchmarks. Oversee and support EDI, Medicare (CMS), NCCI, and reinsurance reporting, partnering closely with Information Services and Finance to resolve data, system, and financial issues. Collaborate with Information Services to analyze claims technology needs, test and implement system enhancements, and validate system changes to ensure data integrity. Support claims financial accuracy through audit assistance, reconciliation efforts, and collaboration on recoveries and accounting issues. Develop, document, and maintain claims procedures, best practices, and internal resources to promote consistency and operational excellence. Provide training, coaching, and mentoring to claims staff, and contribute to training development, delivery, and claims hiring processes. Monitor emerging legal, regulatory, and industry trends in workers' compensation and support readiness for expansion into new jurisdictions.

What We'll Like About You:

Education and Experience Bachelor's degree or an equivalent combination of education and relevant work experience Seven or more years of experience handling workers' compensation claims or similar roles in the property and casualty industry; multi jurisdictional experience preferred Experience in technical claims support, compliance, auditing, financial reconciliation, claims systems analysis, or similar operational support functions preferred Familiarity with IAIABC Claims EDI Reporting Standards preferred Experience with reporting or analytics tools such as Cognos, Tableau, or Power BI preferred Professional insurance designations related to area of expertise preferred Advanced knowledge of workers' compensation claims handling and applicable laws and regulations Knowledge and Skills Strong analytical, research, and problem solving skills with the ability to interpret data and support sound decisions Strong technical aptitude with claims systems, data, reporting tools, and Microsoft Office applications such as Excel and Word Excellent verbal, written, and presentation skills with the ability to collaborate, coach, and support employee development Ability to manage difficult conversations, maintain confidentiality, and exercise sound judgment and discretion Highly organized with the ability to manage multiple priorities in a fast paced environment while maintaining strong customer service and partnership across teams Ability to work onsite in the office when needed Why You'll Love Working Here We want your work life to feel balanced, rewarding, and supported. Here are just a few of the benefits SFM offers: Comprehensive medical, dental, and vision coverage (plus HSA/FSA options). Significant Cash Benefit if You Opt Out of Our Health Plan Flexible hybrid work environment. 401(k) with both Traditional and Roth options + company match. Contributions toward student loan repayment. Generous PTO, 9 paid holidays, and paid parental leave. Monthly home internet allowance. Free life insurance, short-term & long-term disability coverage. Incentive bonus opportunities. Adoption financial assistance. Pet insurance. Annual company-wide volunteer day. Discounts on gyms, fitness apps, and wellness programs. Who We Are SFM is the leading workers' compensation insurer in Minnesota, with a growing presence across the Midwest. We're proud to be recognized as a Top Workplace (#8 midsize employer in MN) thanks to our supportive culture, commitment to our employees, and focus on doing what's right. Learn more by clicking here. The base pay posted is just one component of SFM's total compensation package. The salary range listed represents the full compensation range for this position. Job title and starting pay will be based on the selected candidate's relevant knowledge, skills, abilities and/or experience, and education, if applicable as well as internal equity with other employees in the same job classification. Work Environment and Physical Demands Work takes place in a remote semi paperless environment within a home office setting or in-office setting, using standard office equipment such as computers, phones, and photocopiers, which requires being stationary for extended periods of time. While performing the duties of this job, the employee is regularly required to talk or hear, and maintain concentration and focus. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions. Regular attendance is required. SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. SFM provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, status with regard to public assistance, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. SFM Companies, EEO/AA Employers . SFM is a participant of E-Verify. Applicants have rights under Federal Employment Laws.