Senior Workers' Comp Claims Investigator

Old Republic Commercial Risk; City of Rochester (NY); On-site; USD 65,000 - 95,000; Full time

Job summary

Old Republic Commercial Risk is seeking a Claims professional in the Rochester, NY area to independently investigate, evaluate and resolve high-complexity workers' compensation claims. You will determine coverage, compensation, and potential subrogation, while adhering to statutes and policy provisions.

You will work with PMA nurses on return-to-work strategies and coordinate with vendors to balance cost and outcomes, maintaining strong communication with clients and colleagues.

Qualifications

• Bachelor's degree or 4+ years of equivalent work experience in insurance preferred.
• Familiarity with Workers' Compensation regulations and terminology.
• Ability to travel for business purposes (less than 10%).

Responsibilities

• Investigates all assigned claims with minimal supervision, including complex matters
• Determines coverage, compensability, subrogation potential, and state-specific requirements
• Alerts supervisors to potentially suspect claims and manages reserves with documented rationale
• Executes timely denial or payment of benefits according to jurisdictional law
• Negotiates settlements within authority and develops action plans for case resolution
• Collaborates with PMA nurses to implement return-to-work strategies
• Selects and manages vendors to balance expense with loss outcomes
• Maintains knowledge of jurisdictional requirements and applicable case law
• Communicates effectively with internal and external parties on claims and account issues
• Provides high-quality customer service during reviews and stewardship meetings

Skills

Claims investigations

Communication

Negotiation

Customer service

Regulatory knowledge

Education

Bachelor's degree

Tools

MS Office

Job description

Old Republic Commercial Risk is seeking a Claims professional in the Rochester, NY area to independently investigate, evaluate and resolve high-complexity workers' compensation claims. You will determine coverage, compensation, and potential subrogation, while adhering to statutes and policy provisions.

You will work with PMA nurses on return-to-work strategies and coordinate with vendors to balance cost and outcomes, maintaining strong communication with clients and colleagues.