Workers' Compensation Claims Specialist

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

📋 Description

• Conduct thorough investigations into coverage matters, assess compensability, and oversee high-exposure Workers’ Compensation claims that involve catastrophic injuries and intricate cases.

• Set and adjust reserves throughout the claim's lifecycle and provide documentation to support the rationale.

• Resolve claims within designated authority limits and make independent recommendations regarding case value to senior leadership for cases that exceed authority.

• Engage in reserving, pricing, and strategic discussions with senior leadership.

• Work alongside external defense counsel to manage litigated files in accordance with litigation management protocols.

• Collaborate with medical providers, customers, and injured workers to ensure appropriate medical treatment and prompt submission of medical invoices.

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

• Provide exceptional customer service to policyholders, agents, injured workers, medical providers, legal representatives, and vendors.

• Adhere to escalation and reporting protocols for claims presenting significant exposure.

• Formulate resolution strategies for complex losses utilizing both internal and external resources.

• Maintain documentation of claim files according to company standards and regulatory requirements.

• Recognize subrogation opportunities and identify red flags that necessitate SIU involvement.

• Mentor and train new team members.

• Serve as a technical resource for less experienced claims representatives.

• Report directly to the Workers’ Compensation Complex Claims Team Lead.

⛳️ Requirements

• An active adjuster license is required.

• A minimum of 10 years of experience in handling complex workers’ compensation claims.

• Familiarity with structured settlements and Medicare Set-Asides.

• A BA/BS degree is mandatory.

• AIC, SCLA, CPCU, or other relevant industry designations are advantageous.

• In-depth knowledge of Workers’ Compensation regulations, laws, and best practices.

• Preferred experience in multi-state Workers’ Compensation claims in CT, DE, MI, NH, RI, VA, MA, PA, MN, and WV.

• Outstanding organizational, leadership, communication, and time management capabilities.

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

• Strong analytical, organizational, and time management competencies.

• Exceptional written and verbal communication skills.

• Capacity to work independently and adhere to assigned deadlines.

• Strong negotiation abilities.

• Proficient multitasking skills and the ability to effectively prioritize tasks amid frequent interruptions.

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

• Highly detail-oriented.

• Ability to perform under pressure and exercise sound judgment in sensitive circumstances.

• Advanced verbal and written communication skills for engaging with both internal and external stakeholders.

• Commitment to maintaining continuing education requirements.

🏝️ Benefits

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

• Comprehensive dental plan that includes orthodontia coverage.

• Generous paid time off (PTO) plan.

• Paid company holidays along with 4 floating holidays.

• Paid parental leave policy.

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

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

• Service Recognition Program that provides a monetary award towards a vacation every 5 years of employment.

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

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

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

• Fully remote work arrangement available.

• Occasional travel required for mediations, training sessions, and departmental meetings.