Advanced WC Claims Investigator & Negotiator

OhioX; United States; Remote; USD 70,000 - 129,000; Full time

Benefits offered by this job

Medical/dental/vision

401(k) with company match

Pension plan

Paid time off

Life insurance

Job summary

Nationwide is seeking a Claims Specialist II, Workers’ Compensation, to investigate medical and loss-of-time claims across states. You will determine eligibility, establish reserves, and coordinate care with providers to ensure fair resolutions and cost control.

You will communicate with policyholders, injured workers, and medical professionals, and collaborate with internal teams on settlement and subrogation when appropriate.

Qualifications

• Undergraduate studies in business administration or related field preferred and/or relevant Workers’ Compensation experience.
• State licensing where required. Successful completion of required/applicable claims certification training/classes.
• Three to five years prior experience in workers’ compensation claims.

Responsibilities

• Investigate and handle medical and/or loss-of-time workers’ compensation claims; determine compensability and benefits.
• Establish case reserves and manage claims to resolution with best practices.
• Communicate frequently with customers, injured workers and medical providers.
• Pursue third party recoveries and coordinate with SIU or subrogation as needed.
• Assist with budgeting and litigation coordination with counsel as appropriate.

Skills

Investigative skills

Negotiation

Customer service

Education

Undergraduate studies in business administration

Tools

Claims system

Job description

Nationwide is seeking a Claims Specialist II, Workers’ Compensation, to investigate medical and loss-of-time claims across states. You will determine eligibility, establish reserves, and coordinate care with providers to ensure fair resolutions and cost control.

You will communicate with policyholders, injured workers, and medical professionals, and collaborate with internal teams on settlement and subrogation when appropriate.