Claims Specialist II, Workers Compensation (California jurisdiction)

Nationwide; United States; Remote; USD 50,000 - 70,000; Full time

Job summary

Nationwide is seeking a Claims Specialist to manage workers compensation claims. The role involves investigating claims, ensuring customer satisfaction, and maintaining communication with policyholders and medical providers. Ideal candidates will have strong claims handling and customer service skills, along with experience in workers compensation.

Qualifications

• Strong workers compensation or loss time claims experience preferred.
• Demonstrated California Workers Compensation claims handling experience preferred.

Responsibilities

• Investigate and handle medical and/or loss-of-time workers compensation claims.
• Establish timely and appropriate case reserves aligned with Best Practices.

Skills

Customer Service

Communication

Negotiation

Job description

If you’re passionate about helping people protect what matters most to them, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide, “on your side” goes beyond just words. Our customers are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care.

Work Environment: The location of this position is flexible and open to virtual and/or remote based applicants.

What to expect: This individual will manage a varying degree of workers compensation claim complexity for all Nationwide channels; inclusive but not limited to: Agribusiness, Standard Commercial, and E&S. Members are unique in that they could be commercial business owners, farms, small businesses, or amusement parks.

The ideal candidate will have:

• Strong workers compensation, or loss time claims experience is highly preferred.
• Demonstrated California Workers Compensation claims handling experience is highly preferred.
• Prior litigation and insurance experience is preferred.
• Strong customer service, written & verbal communication skills.

Job Description Summary

Do you have a strong desire to provide prompt, courteous and fair service to customers? Are you a skilled investigator, negotiator and communicator? If you thrive in an environment where you can problem-solve workers’ compensation claims resolution, while following processes that provide fair resolution, customer satisfaction and cost management, then we want to hear from you!

As a Claims Specialist, you’ll investigate and handle medical and/or loss-of-time workers compensation claims from multiple states to determine compensability, entitled benefits, average weekly wage and benefit rate according to applicable state workers’ compensation statute. We’ll count on you to promote and provide exemplary customer service. Key to success will be your ability to establish timely and appropriate case reserves aligned with Best Practices and manage claims to appropriate resolution. You’ll also communicate frequently with customers, injured workers and medical providers.

Key Responsibilities:

• Provides appropriate notices to policyholders and injured employees according to applicable state workers’ compensation statute and obtains appropriate forms and documentation to verify employee/employer relationship and average weekly wage. Completes and files appropriate first and second notice of injury as required by individual state workers’ compensation statute and electronic data interchange reporting regulations.
• Employs appropriate claims management techniques and direct intervention (e.g., independent medical examinations, referral for rehabilitation, utilization review, etc.) to manage each claim. Maintains contact with policyholders and injured worker and pursues return to work initiatives. Utilizes effective Telephonic Nurse Case Manager or Field Nurse Case Management services to assist with managing medical care and return to work activities. Consults with internal Claims Medical Specialist for future care needs and issues of life expectancy. Evaluates exposures, manages ongoing case reserves in alignment with best practices and negotiates settlements as appropriate. Documents significant activity and decisions in each claim via on-line claim system.