Claims Specialist II, Workers Compensation (NE Region)

Zurich NA; West Virginia; Hybrid; USD 60,000 - 98,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

Zurich North America seeks an experienced Workers’ Compensation Claims Specialist II to support the Northeast region. The role offers a hybrid schedule from Parsippany or Boston offices, or a fully remote setup based in CT, DE, ME, MA, NH, NJ, NY, PA, RI, VT, VA, or WV.

You will manage low to high exposure workers' compensation claims, determine liability and coverage, develop case strategy, set reserves, negotiate within authority, and ensure timely, customer-focused service while complying

Qualifications

• Bachelor’s Degree and 3+ years of experience in the Claims or Insurance area.
• Zurich Certified Insurance Apprentice, including an Associate Degree and 3+ years of experience in Claims or Insurance area.
• Completion of Zurich Claims Training Program and 2+ years of experience in the Claims or Insurance area.
• High School Diploma or Equivalent and 5+ years of experience in the Claims or Insurance area AND Must obtain and maintain required adjuster license(s)

Responsibilities

• Document claims data in compliance with best practices.
• Determine liability by analyzing facts and applicable law.
• Verify policy coverage and determine losses within authority.
• Develop case strategy and evaluations to resolve claims promptly.
• Establish reserves and monitor throughout claims cycle within authority.
• Assess damages and negotiate settlements within limits.
• Maintain customer communications and confidentiality.
• Refer claims to subrogation and fraud teams when applicable.

Skills

Communication skills

Analytical skills

Education

Bachelor's Degree

Zurich Certified Insurance Apprentice

High School Diploma

Tools

Microsoft Office

Job description

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 judgement 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 experience
• Experience 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.

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 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.

• 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