Job Description
Sr. Workers Comp Claims Rep (Hybrid/Remote)
Job Category: CLAIMS
Requisition Number: SRWOR004509
- Full-Time
- LocationsShowing more locations*Remote- USA
United StatesCharlotte, NC 28277, USA
Job Details
Description
A new job is a big decision. Don’t work just anywhere. Be Selective!
Our Business
Selective is a midsized U.S. domestic property and casualty insurance company with a history of strong financial performance for over 95 years. Focused on exceptional employee and customer experience, we are frequently recognized for awards and honors, including being named to Forbes’ 2021 Best Workplaces in Financial Services and Insurance list.
Our Culture
We genuinely care about each other, our customers, and the communities in which we operate. Our leaders actively champion career development and invite us to voice unique ideas and diverse perspectives. If that sounds appealing, we think you would feel inspired on our team to achieve and be rewarded for extraordinary results.
Selective Insurance is seeking a Sr. Workers Comp Claims Rep for our Charlotte, NC office which will include a hybrid work option (2 days in the office and 3 days remote). *We will also consider remote for the ideal candidate if they reside outside of NC and SC.*
This position will be responsible for Investigating lost-time claims to determine coverage and compensability based on jurisdictional guidelines. Obtain relevant information necessary for a thorough investigation, be able to freeze facts of claims and make timely decisions. Effective and consistent partnership with nurse management to return injured worker back to gainful employment when necessary. Manage litigation of cases in collaboration with Staff and Panel Counsel. Manage administration of benefits and claim resolution. Provide compelling customer service. Responsibility includes effective and timely communication with employer, employee, and medical provider.
JOB RESPONSIBILITIES;
- Receives assigned lost-time claims for investigation to determine coverage and compensability on claims with a disability period greater than 10 weeks.
- Processes claims which include the following activities: Making contacts, setting reserves, establishing file in MCS, evaluating exposure and establishing initial and subsequent reserves on claims with an exposure greater than $25,000, and analyzing investigational data. Makes timely payments and follows through to resolution.
- Handles both non-litigated and litigated cases.
- Collaborates with nurses and vendors on medical and disability management. Collaborates with Staff Counsel or Panel Counsel on litigated cases.
- Documents claims files and maintains control of work through documentation or diary system.
- Handles disputed facts, benefits, compensability, coverage, medical causality and relatedness.
- File state forms timely in accordance with statutory guidelines.
- Prepare for and participate in claims review and settlement conferences.
- Ensures compliance with company, state and federal regulations.
JOB QUALIFICATIONS:
- College degree preferred.
- 3 – 5 years claims experience preferred.
- Knowledge of workers compensation statutes, coverage and case law.
- Excellent written and verbal communication skills.
- Working knowledge of medical treatment and terms as related to medical only workers compensation claims.
- Critical thinking skills to assess compensability of WC claim as it relates to the facts and law.
Salary range: $59,400 – $97,700. The actual base salary is based on geographic location, and the range is representative of salaries for this role throughout Selective’s footprint. Additional considerations include the candidate’s qualifications and experience.
Selective is an Equal Employment Opportunity employer. That means we respect and value every individual’s unique opinions, beliefs, abilities, and perspectives. We are committed to promoting a welcoming culture that celebrates diverse talent, individual identity, different points of view and experiences – and empowers employees to contribute new ideas that support our continued and growing success. Building a highly engaged team is one of our core strategic imperatives, which we believe is enhanced by diversity, equity, and inclusion. We expect and encourage all employees and all of our business partners to embrace, practice, and monitor the attitudes, values, and goals of acceptance; address biases; and foster diversity of viewpoints and opinions.
Selective maintains a drug-free workplace.