Senior Workers' Comp Claims Investigator

Old Republic Commercial Risk; City of Utica (NY); On-site; USD 75,000 - 105,000; Full time

Job summary

Old Republic Commercial Risk in Utica, NY seeks an experienced Claims professional to independently handle complex Workers’ Compensation claims. You will investigate, evaluate, and resolve assigned claims, determine coverage and reserves, and coordinate with medical providers to achieve timely, fair outcomes.

You will negotiate settlements within authority and manage litigations, while ensuring compliance with state regulations and company standards. Travel is minimal.

Qualifications

• Bachelor's degree or 4+ years in insurance required
• CA experience required; AZ experience a plus
• License required or obtainable within 90 days
• Familiarity with Workers' Compensation regulations expected
• Strong organizational skills and ability to multitask
• Proficient in MS Office (Word, Excel, PowerPoint)

Responsibilities

• Investigate assigned claims with minimal supervision, including complex cases
• Determine coverage, compensability, subrogation potential, and second injury fund when applicable
• Alert Supervisor and SIU to potentially suspect claims
• Ensure timely denial or payment of benefits per jurisdictional requirements
• Establish reserves with rationale and adjust over the life of the claim
• Negotiate settlements within granted authority
• Develop action plans for case resolution including medical/disability management, litigation, and negotiation
• Collaborate with PMA nurses to execute return-to-work strategies
• Select and manage service vendors to balance costs and loss outcomes
• Maintain knowledge of jurisdictional requirements and case law for states served
• Demonstrate proficiency through timely execution of best claim practices
• Communicate effectively with internal and external parties
• Provide high level customer service during reviews and meetings
• Authorize treatment per PMA protocols
• Suggest panel providers per state statutes
• Adhere to Code of Business Conduct and ethics

Skills

Communication

Organization

Critical thinking

Attention to detail

Independent worker

Education

Bachelor's degree

AIC designation

Tools

MS Office

Word

Excel

PowerPoint

Job description

Old Republic Commercial Risk in Utica, NY seeks an experienced Claims professional to independently handle complex Workers’ Compensation claims. You will investigate, evaluate, and resolve assigned claims, determine coverage and reserves, and coordinate with medical providers to achieve timely, fair outcomes.

You will negotiate settlements within authority and manage litigations, while ensuring compliance with state regulations and company standards. Travel is minimal.