Senior Workers' Compensation Claims Representative – Northeast

This is a fully remote position, open to applicants in United States.

📋 Description

• Investigate coverage, assess compensability, and oversee a caseload of Workers’ Compensation claims across various jurisdictions.

• Proactively establish and adjust reserves throughout the claim's duration, documenting the supporting rationale.

• Resolve claims within established authority and provide independent case value recommendations to senior leadership for cases that exceed authority limits.

• Engage in reserving, pricing, and strategy discussions with leadership.

• Collaborate with external defense counsel to manage litigated files in accordance with litigation management guidelines.

• Partner with medical providers, customers, and injured workers to ensure appropriate medical treatment and timely submission of medical bills.

• Ensure adherence to state and federal Workers’ Compensation regulations.

• Deliver customer service to policyholders, agents, injured workers, medical providers, legal contacts, and vendors.

• Document claim files in compliance with company and regulatory standards.

• Identify potential subrogation opportunities and flag issues requiring SIU involvement.

• Mentor new and developing team members through coaching, technical guidance, and assistance with complex issues.

• Lead onboarding and training programs for newly hired claims representatives.

• Collaborate with leadership to identify training needs, create educational materials, and support continuous improvement initiatives.

• Act as a senior technical resource on intricate claim issues, strategic decision-making, reserving, litigation management, and settlement evaluations.

• Perform additional duties as assigned.

⛳️ Requirements

• Active adjuster license is mandatory.

• A minimum of 7 years of experience managing litigated workers’ compensation claims.

• Exceptional organizational and leadership capabilities.

• Experience with structured settlements and Medicare Set-Asides.

• Ability to thrive in a fast-paced, collaborative, virtual office environment.

• Strong analytical, organizational, and time management skills.

• Excellent written and verbal communication abilities.

• Capacity to work independently and meet deadlines.

• Strong negotiation skills.

• Ability to manage multiple tasks and effectively prioritize amidst frequent interruptions.

• Proficient in MS Word, Excel, and internet applications.

• Highly detail-oriented.

• Capable of working under pressure and exercising sound judgment in sensitive situations.

• Advanced verbal and written communication skills.

• Proven experience in training, mentoring, or coaching claims professionals within a Workers’ Compensation context.

• BA/BS degree is required.

• Must maintain continuing education requirements.

🏝️ Benefits

• Medical (PPO/HDHP), vision, disability, and life insurance.

• Enhanced dental plan with orthodontia coverage alongside a standard plan.

• Generous PTO plan for all employees eligible for benefits.

• Paid company holidays and 4 floating holidays.

• Paid parental leave.

• Employee Retirement Savings Plan/401(k) with company matching and immediate vesting.

• Education Assistance Program providing 100% upfront tuition reimbursement after 6 months of service for approved degree programs.

• Service Recognition Program offering a monetary award for vacation every 5 years of employment.

• Wellness Initiatives including Fitness Center and Weight Watchers Reimbursement programs.

• Voluntary accident, critical illness, and hospital indemnity benefits.

• Employee discount and rewards program on travel, tickets, electronics, home, and more.

• Full-time remote work option.

• No bonus potential.