Senior Workers’ Comp Claims Investigator

Old Republic Commercial Risk; City of Syracuse (NY); Vor Ort; USD 70.000 - 95.000; Vollzeit

Zusammenfassung

Old Republic Commercial Risk is seeking a Claims professional to independently investigate, evaluate, and resolve complex workers' compensation claims. You will determine coverage, reserves, and potential subrogation while coordinating with PMA nurse professionals for return-to-work strategies.

Required are a Bachelor's degree (or 4+ years in insurance), CA experience, and the ability to obtain licensure within 90 days. Strong organizational, analytical and communication skills are essential.

Qualifikationen

• Bachelor's degree or four+ years of related work experience.
• CA experience required; AZ experience is a plus.
• AIC designation or similar professional designation desired
• License required or ability to obtain license within 90 days in mandated states
• Familiarity with medical terminology and Workers' Compensation
• Strong organizational and communication skills

Aufgaben

• Investigates assigned complex workers' compensation claims promptly and with minimal supervision.
• Determines coverage, compensability, potential subrogation and second injury fund when applicable.
• Alerts Supervisor and SIU to suspect claims and ensures timely denial or payment of benefits.
• Establishes reserves with rationale and adjusts them as exposure changes.
• Negotiates settlements within granted authority and plans case resolution including medical and disability management.
• Collaborates with PMA nurse professionals on return-to-work strategies.
• Manages service vendors to balance expense and loss outcomes.
• Maintains knowledge of jurisdictional requirements and applicable case law.
• Communicates with internal/external parties effectively, in writing and verbally.
• Provides high level of customer service during reviews and stewardship meetings.
• Authorizes treatment per statute and PMA Managed Care protocols; supports PMA clients with panel provider information.
• Demonstrates compliance with Company policies and ethics.

Kenntnisse

Analytical thinking

Communication

Customer service

Time management

Independent work

Attention to detail

Ausbildung

Bachelor's degree

AIC designation

Tools

MS Office

Word

Excel

PowerPoint

Jobbeschreibung

Old Republic Commercial Risk is seeking a Claims professional to independently investigate, evaluate, and resolve complex workers' compensation claims. You will determine coverage, reserves, and potential subrogation while coordinating with PMA nurse professionals for return-to-work strategies.

Required are a Bachelor's degree (or 4+ years in insurance), CA experience, and the ability to obtain licensure within 90 days. Strong organizational, analytical and communication skills are essential.