Workers Compensation Claims Specialist, East

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

📋 Description

• Executes a range of responsibilities in alignment with departmental standards: Oversees an inventory of commercial claims with moderate to high complexity and exposure, adhering to company protocols to confirm policy coverage, conduct investigations, formulate resolution strategies, and authorize disbursements within established authority limits.

• Delivers outstanding customer service by engaging professionally and effectively with insured individuals, claimants, and business partners, meeting quality and cycle time objectives, providing consistent and timely updates, and responding swiftly to inquiries and requests for information.

• Confirms coverage and sets timely and sufficient reserves by analyzing and interpreting policy language and collaborating with coverage counsel on complex cases, estimating potential claim values, and adhering to the company's claim handling procedures.

• Conducts targeted investigations to assess compensability, liability, and covered damages by collecting relevant information, such as contracts or other documentation, recording statements from customers, claimants, injured workers, witnesses, and coordinating with experts or other parties as necessary to verify the claim facts.

• Develops and sustains working relationships with relevant internal and external partners, suppliers, and experts by identifying and collaborating with necessary resources to effectively resolve claims.

• Authorizes and ensures claim disbursements within authority limits by assessing liability and compensability, negotiating settlements, and escalating issues to management as needed.

• Aids in expense management by resolving claims promptly and accurately, selecting and actively supervising suitable resources, and providing high-quality service.

• Recognizes and addresses subrogation/salvage opportunities or potential fraud incidents by evaluating claim facts and referring cases to the appropriate Recovery or SIU resources for further investigation.

• Meets quality standards on every file by adhering to all company guidelines, achieving quality and cycle time targets, ensuring proper documentation, and issuing appropriate claim disbursements.

• Maintains compliance with state and local regulatory requirements by following company protocols and staying informed on commercial insurance laws, regulations, or trends relevant to the line of business.

• May serve as a mentor or coach to less experienced claims professionals.

• May undertake additional responsibilities as assigned.

⛳️ Requirements

• Bachelor’s Degree or equivalent experience.

• Typically requires a minimum of four years of relevant experience, ideally in claims handling.

• Candidates who have successfully completed the CNA Claim Training Program may be considered after two years of claims handling experience.

• Must possess or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.

• Professional designations are advantageous (e.g., CPCU).

• Strong working knowledge of the commercial insurance sector, including products, policy language, coverage, and claims practices.

• Excellent verbal and written communication skills, with the capability to foster positive working relationships and convey information to customers, claimants, and senior management as required.

• Proven ability to cultivate collaborative business relationships with both internal and external partners.

• Capability to exercise independent judgment, resolve moderately complex issues, and make sound business decisions.

• Demonstrated investigative experience with analytical and critical thinking skills.

• Strong work ethic, evidenced by effective time management and organizational abilities.

• Proven capacity to handle multiple priorities in a fast-paced, collaborative environment while maintaining high productivity levels.

• Developing ability to negotiate low to moderately complex settlements.

• Adaptability to a changing environment.

• Proficiency in Microsoft Office Suite and ability to learn business-related software.

• Proven ability to appreciate diverse opinions and ideas.

🏝️ Benefits

• Comprehensive and competitive benefits package designed to assist our employees – and their family members – in achieving their physical, financial, emotional, and social wellbeing goals.

• Health insurance

• 401(k) matching