The Insurance Review Specialist is responsible for resolving coverage, employment, and date-of-injury disputes that prevent workers’ compensation claims from advancing through the discovery process. This is a production-driven, investigative role. The specialist works a daily assigned case queue, identifies the specific issue blocking each claim, takes documented action toward resolution, and escalates appropriately when a decision requires attorney input. The goal on every case is a clear next step, a hard deadline, and a record that shows what was done and why.

What this role is not:

- A holding queue manager — cases are not parked, they are resolved or escalated with a documented rationale.
- A clerical role — the specialist is expected to conduct independent research, identify discrepancies, and reach conclusions.
- A reactive role — the specialist does not wait to be told which cases to work; they are assigned a daily list and are accountable for completing it.
- Key Responsibilities

Daily Case Review

- Complete a the minimum required insurance review cases per day from an assigned queue, prioritized by age of case (oldest first).
- For each case, identify the specific blocker: wrong employer, no insurance found, wrong insurance carrier, independent contractor dispute, or date-of-injury discrepancy.
- Document every review with the issue identified, action taken, and the specific next step with a target date.
- Submit an end-of-day report to the supervisor at the end of every working day.

Investigation & Research

- Search WCIRB, SOS (Secretary of State), employer websites, and other sources to identify or verify insurance carriers and employer identity.
- Review proof of employment (POE) documents — paystubs, W-2s, offer letters, ID — and identify discrepancies in employer name, address, or payroll source.
- Identify when a carrier mismatch, wrong employer, or coverage gap exists and take the correct corrective action (amendment, outreach to opposing counsel, or other escalation).

Client & Third-Party Communication

- Contact clients (CTs) by phone, text, and email to request missing documentation, clarify employment details, or advise on next steps.
- Communicate effectively with clients when applicable, using appropriate language access resources.
- Reach out to adjusters,



opposing counsel, and carriers to verify coverage or resolve discrepancies.

Escalation & Case Disposition

- Escalate IC, DOI, and employment-status disputes to the supervising attorney with a concise case summary — not open-ended questions.
- Recognize when a case requires an amendment (wrong employer, wrong carrier) and complete or initiate that amendment without waiting to be prompted.
- Flag cases that cannot be resolved within the insurance review step and recommend a path: MSC, disengagement, or further investigation.

Who Succeeds in This Role

The following qualities consistently distinguish high performers in insurance review from those who struggle. These are not soft skills — they are operational requirements.

Investigative instinct

The best candidates do not stop at the first dead end. When WCIRB returns no result, they search by address. When a paystub shows one employer name and SOS shows another, they flag the discrepancy and find out why. When a CT is unresponsive, they try every channel— they don’t assume the case is stuck. They treat each case like a puzzle with a solvable answer.

Documentation discipline

High performers write notes that a colleague could pick up and understand with no context. They document what they found, what they did, what the result was, and what happens next and when. They never write the same note twice on a case without showing what changed. They understand that undocumented work is, legally and operationally, work that did not happen.

Case ownership

They do not treat escalation as the end of their responsibility. When they send a case to the attorney for a decision, they track the response and follow up if it does not come back. They do not park cases waiting on others without a logged deadline. They know which of their cases are stuck and why, and they are never surprised by an old case resurfacing without having been touched.





Output orientation

This role has a daily production target. Candidates who thrive here understand that volume and quality are both non-negotiable — not trade-offs. They manage their time to work the oldest, hardest cases in the morning when they are fresh, and use the afternoon for higher-volume, lower-complexity reviews. They do not self-select easier cases to inflate their count.

Judgment under ambiguity

Many cases in insurance review do not have clean answers. Employment status is disputed. A carrier is identified but coverage is denied. A CT provides inconsistent information across multiple contacts. The specialist must be able to assess what is known, identify what is missing, and make a reasoned recommendation — not simply wait for someone to tell them what to do.

Qualifications

Required

- 1 year of experience in a workers’ compensation, personal injury, or insurance-related legal or claims environment.
- Demonstrated ability to manage a high-volume case queue with consistent daily output.
- Proficiency with case management systems and comfort pulling and interpreting data from those systems.
- Strong written communication skills — notes and reports must be clear, specific, and professionally written.
- Ability to conduct independent research using WCIRB, SOS, public records, and web sources.
- Organized, deadline-driven, and comfortable working without close supervision on a day-to-day basis.
- Bilingual (English, Spanish)

Not required, but worth noting

A legal degree is not required or expected. What matters is the ability to think analytically, write clearly, work at volume, and take ownership of outcomes. Candidates who have excelled in claims investigation, paralegal support, or insurance verification roles often transition well into this position.

Job Type: Full-time

Application Question(s):

- Are you fully bilingual in English and Spanish?
- Do you have experience in Workers' Compensation or insurance review experience?
- How would you describe your problem-solving approach when handling a complex or unfamiliar case?
- How comfortable are you working independently in a fully remote environment while managing multiple tasks and deadlines?

Work Location: Remote

📌 Legal Insurance Review Specialist (Workers Compensation) (Colombia)
🏢 Abramson Labor Group
📍 Colombia