Senior WC Claims Specialist — Hybrid (In/Remote)

Selective Insurance Company of America; Charlotte (NC); Hybride; USD 69 000 - 89 000; Plein temps

Résumé du poste

Selective Insurance Company of America in Charlotte, NC, seeks a Senior Workers' Compensation (WC) Claim Representative for a hybrid role with 2 days in the office and 3 days remote.

Responsibilities include investigating lost-time claims, determining coverage and compensability, coordinating with nurses and management to return injured workers to work, and handling both litigated and non-litigated cases while ensuring regulatory compliance.

Qualifications

• Knowledge of workers compensation statutes, coverage, and case law.
• Excellent written and verbal communication skills.
• Working knowledge of medical treatment and terms as related to medical only workers compensation claims.
• Critical thinking skills to assess compensability of WC claim as it relates to the facts and law.

Responsabilités

• Investigate lost time claims to determine coverage and compensability.
• Obtain information for thorough investigations and freeze facts.
• Coordinate with nurses and management to facilitate return to work.
• Manage litigation with staff/panel counsel.
• Document claims files and maintain control via diary system.
• Handle disputed facts, benefits, compensability, coverage and related issues.
• File state forms timely in accordance with statutory guidelines.
• Prepare for and participate in claims review and settlement conferences.

Connaissances

WC knowledge

Communication skills

Critical thinking

Medical terminology

Formation

College degree preferred

Description du poste

Selective Insurance Company of America in Charlotte, NC, seeks a Senior Workers' Compensation (WC) Claim Representative for a hybrid role with 2 days in the office and 3 days remote.

Responsibilities include investigating lost-time claims, determining coverage and compensability, coordinating with nurses and management to return injured workers to work, and handling both litigated and non-litigated cases while ensuring regulatory compliance.