Claims Specialist II, Workers Compensation (NE Region)

Zurich NA; Vermont; Hybride; USD 60 000 - 98 000; Plein temps

Résumé du poste

Zurich North America is seeking an accomplished Workers Compensation Claims Specialist II for our Northeast region. The role offers a hybrid work schedule from Parsippany or Boston offices, or a fully remote setup based in one of several states including Vermont.

You will handle multi-party WC claims with varying exposure and complexity, ensuring efficient, customer-centric service while adhering to regulatory requirements.

Qualifications

• Bachelor’s Degree and 3+ years of experience in the Claims or Insurance area OR

Responsabilités

• Document claims file by accurately capturing and updating claims data in compliance with best practices for low to moderate exposure and complexity personal or commercial line claims.
• Exercise judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.
• Analyze coverage determination by reviewing applicable coverage for claims and determining whether loss falls within coverage.
• Develop case strategy and evaluation to achieve timely resolution of claims.
• Establish reserves and review throughout claims cycle within authority limits; estimate and validate claim value.
• Assess damages and calculate applicable damages or ranges allowed by law.
• Negotiate settlements within authority; develop negotiation strategy.
• Follow best practices to meet quality standards and ensure customer service.
• Manage expenses by working with vendors; ensure alignment with internal controls.
• Refer claims to subrogation and fraud teams as appropriate.
• Contribute risk insights and trends to Business Unit or customers.
• Maintain confidentiality of claims information and stay current with industry trends.

Connaissances

Excellent communication skills

Analytical skills

Negotiation experience

Knowledge of insurance regulations

Formation

Bachelor’s Degree

Zurich Certified Insurance Apprentice

Zurich Claims Training Program

High School Diploma or Equivalent

Outils

Microsoft Office

Description du poste

Zurich is looking for an accomplished Workers Compensation Claims Specialist II for our Northeast region. This position offers a hybrid work schedule from our Parsippany or Boston offices, or a fully remote setup based in one of the following states: Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, or West Virginia.

The Workers Compensation Claims Specialist will handle multi-party commercial line Workman’s Compensation claims of low to high exposure and complexity within specific authority limits, to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.

In this role you will be responsible for:

• Document claims file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate exposure and complexity personal or commercial line claims.
• Exercise judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.
• Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
• Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.
• Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
• Assess damages by calculating applicable damages or range of damages allowed by law.
• Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
• Meet quality standards by following best practices.
• Ensure customer service by proactively communicating information; responding to inquiries; following customer protocols and may participating in customer marketing efforts.
• Manage expenses by working within vendor approved networks and managing scope of work assigned to outside contractors. Departs from approved vendors with manager approval, where in the best interests of the insured.
• Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
• Refer claim to subrogation and fraud teams by identifying potential subrogation and fraud.
• Contribute to profitable growth by providing risk insight, information and trends to Business Unit or customer as needed.
• Protect Zurich’s reputation by keeping claims information confidential.
• Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks. And participating in professional societies.

Basic Qualifications:

• Bachelor’s Degree and 3 or more years of experience in the Claims or Insurance area OR
• Zurich Certified Insurance Apprentice, including an Associate Degree and 3 or more years of experience in Claims or Insurance area OR
• Completion of Zurich Claims Training Program and 2 or more years of experience in the Claims or Insurance area OR
• High School Diploma or Equivalent and 5 or more years of experience in the Claims or Insurance area AND
• Must obtain and maintain required adjuster license(s)
• Knowledge of insurance regulations, markets and products
• Microsoft Office experience

Preferred Qualifications:

• 4+ years of experience in the Workers Compensation line of business
• 3+ years of experience handling litigation management
• Specialization in MA, ME, and VT jurisdictions with knowledge of CT and NH.
• Familiarization of Subsequent Injury Fund in MA
• Learn and handle additional jurisdictions as needed
• EDI filing requirements
• MSA/Medicare knowledge
• WCCA, WCCP Designations
• Knowledge and skill of claims handling
• Negotiation experienceExperience in line of business
• Excellent communication skills
• Analytical skills

Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply—your unique background matters to us. The pay range shown is a national average and may vary by location. The proposed Salary range for this position is $59,900.00 - $98,200.00, with short-term incentive bonus eligibility set at 10%.

We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.]

Why Zurich?

At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment- so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500.

Join us for a brighter future—for yourself and our customers.

Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets.

Zurich complies with 18 U.S. Code

• 1033.

Location(s): AM - New Jersey Virtual Office, AM - Boston, AM - Connecticut Virtual Office, AM - Delaware Virtual Office, AM - Maine Virtual Office, AM - Massachusetts Virt. Office, AM - New Hampshire Virt. Office, AM - New York Virtual Office, AM - Parsippany, AM - Pennsylvania Virtual Office, AM - Rhode Island Virtual Office, AM - Vermont Virtual Office, AM - Virginia Virtual Office, AM - West Virginia Virt. Office

Remote Working: Hybrid

Schedule: Full Time

Employment Sponsorship Offered: No