Claim Specialist II – III

This is a fully remote position, open to applicants in New Hampshire, +1 more state.

📋 Description

• Engages with insured individuals, injured workers, agents, brokers, witnesses, attorneys, loss prevention specialists, and underwriters to gather and convey essential information for assessing coverage/compensability, loss facts, and the extent of liability/exposure.

• Oversees the provision of timely, suitable, and precise indemnity and medical benefits.

• Assesses claim exposure, negotiates, and resolves claims. Collaborates closely with defense counsel on litigated matters and participates in mediation, arbitration, and hearings as required. Formulates a litigation strategy with defense counsel and monitors compliance with the plan to manage legal costs and ensure effective resolution.

• Works in partnership with insureds and employees by conducting visits and presentations as necessary to foster a collaborative approach to claims management.

• Maintains high-quality claim files in line with established best practices and company policies.

• Implements Managed Care strategies, coordinates rehabilitation or medical management, processes bills, reviews all correspondence through Image Right, and tracks progress as appropriate.

• Engages with State and Federal Boards and Commissions while establishing and maintaining adequate reserves as necessary.

• Acts as a mentor and assists in training less experienced Claim Department representatives.

• Stays informed on State regulations and Company procedures related to various claims; educates injured workers and/or insured individuals accordingly.

• Prepares and presents files for Agent/Broker Reviews and Insured File Reviews.

• Possesses knowledge of medical terminology and standard medical practices as they relate to worker’s compensation, U.S. Longshoreman’s, and Jones Act claims.

• Participates in both in-house and external training programs to remain updated on pertinent issues and topics.

• Maintains proficiency in all computer systems currently in operation.

• Travels across States as needed to manage assigned claims inventory.

• Pursues further education in claims through Associate in Claims or Claims Law (AEI) courses.

⛳️ Requirements

• Minimum of three years of experience in handling workers’ compensation lost time claims is required.

• A Bachelor’s degree is preferred.

• Proficiency in computer applications, particularly Word, Excel, and Image Right is preferred.

• A valid driver’s license is mandatory.

• Exceptional attention to detail along with strong verbal and written communication skills.

• Must be adaptable, flexible, and self-motivated with the capability to manage time, multiple priorities, and resources effectively.

• Ability to collaborate effectively with other members of the organizational team is essential.

🏝️ Benefits

• Health Insurance options, Dental Insurance options, and Vision Insurance

• Employee Life Insurance/AD&D and Dependent Life Insurance options

• Short-term & Long-term Disability

• Health Savings Account with potential employer match

• Flexible Medical and Dependent Care Account

• Accident Insurance

• Critical Illness Insurance

• Employee Assistance Program

• Legal/Identity Theft Insurance options

• Long Term Care Insurance

• Pet Insurance

• 401(k) Retirement Plan with a match up to 6%, plus an annual bonus based on individual and company performance.

• 5 weeks of Paid Time Off (PTO)

• 11 paid holidays