Senior Workers' Comp Claims Specialist

Selective Insurance; Charlotte (NC); On-site; USD 60,000 - 78,000; Full time

Job summary

Selective Insurance is seeking a Workers' Comp Claim Rep to handle claims for the South/West Region. Responsibilities include investigating lost time claims, determining coverage and compensability, and collaborating with nurses and vendors to manage medical and disability aspects, while ensuring regulatory compliance.

This role emphasizes timely documentation, file management, and participation in review and settlement conferences.

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.

Responsibilities

• Receives assigned lost time claims for investigation to determine coverage and compensability on claims with a short disability period of 8 weeks or less (could occasionally exceed 8 weeks).
• Processes claims including contacts, setting reserves, establishing file in MCS, evaluating exposure, and establishing initial and subsequent reserves on less severe claims with a general exposure of less than $75,000, and analyzing investigational data.
• Documents claim files and maintains control of work through documentation or diary system.
• Handle non-litigated and litigated claims.
• File state forms timely in accordance with statutory guidelines.
• Collaborate with nurses and vendors on medical and disability management.
• Prepare for and participate in claims review and settlement conferences.
• Ensures compliance with company, state, and federal regulations.

Skills

Workers' compensation knowledge

Communication skills

Critical thinking

Education

College degree preferred

Tools

MCS system

Job description

Selective Insurance is seeking a Workers' Comp Claim Rep to handle claims for the South/West Region. Responsibilities include investigating lost time claims, determining coverage and compensability, and collaborating with nurses and vendors to manage medical and disability aspects, while ensuring regulatory compliance.

This role emphasizes timely documentation, file management, and participation in review and settlement conferences.