Senior WC Claims Specialist - Complex Claims Expert

Old Republic Commercial Risk; Princeton (NJ); On-site; USD 70,000 - 100,000; Full time

Job summary

Old Republic Commercial Risk seeks an experienced workers' compensation claims professional in New Jersey to independently investigate, evaluate and resolve high-complexity claims. You will administer and resolve high-risk claims per legal statutes, policy provisions, and company guidelines.

Responsibilities include investigating claims, determining coverage, negotiating settlements and coordinating return-to-work strategies, while maintaining reserves and ensuring compliance with state

Qualifications

• Bachelor's degree or four or more years of equivalent work experience in an insurance related industry.
• 3-5 years' experience handling lost time workers' compensation claims; NJ and PA jurisdiction experience required.
• Active license required or ability to obtain license within 90 days in mandated states.
• Familiarity with medical terminology and/or Workers' Compensation
• Strong organizational skills with ability to work independently and manage multiple tasks
• Proven critical thinking with attention to detail
• Strong verbal and written communication skills and customer service
• Computer literacy, including MS Word, Excel, PowerPoint
• Ability to travel for business purposes (less than 10%)

Responsibilities

• Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature
• Determine coverage, compensability, potential for subrogation recovery, and second injury fund applicability
• Alert Supervisor and Special Investigations Unit to potentially suspect claims
• Ensure timely denial or payment of benefits per jurisdictional requirements
• Establish and adjust reserves with documented rationale
• Negotiate settlements with client approval
• Implement action plans for case resolution including medical and disability management
• Collaborate with PMA nurses to develop return-to-work strategies
• Select and manage service vendors to balance expense and loss outcomes
• Maintain knowledge of jurisdictional requirements and applicable case law
• Demonstrate technical proficiency through best claim practices
• Communicate effectively with internal and external parties
• Provide high level of customer service during reviews and account-specific sessions
• Authorize treatment per PMA protocols
• Assist PMA clients with panel provider information

Skills

Organizational skills

Critical thinking

Verbal communication

Written communication

MS Office

Travel

Education

Bachelor's degree or 4+ years experience

AIC designation desirable

Tools

MS Office

Job description

Old Republic Commercial Risk seeks an experienced workers' compensation claims professional in New Jersey to independently investigate, evaluate and resolve high-complexity claims. You will administer and resolve high-risk claims per legal statutes, policy provisions, and company guidelines.

Responsibilities include investigating claims, determining coverage, negotiating settlements and coordinating return-to-work strategies, while maintaining reserves and ensuring compliance with state