Senior Workers' Comp Claims Specialist

Old Republic Commercial Risk; Charlotte (NC); On-site; USD 70,000 - 95,000; Full time

Job summary

Old Republic Commercial Risk is seeking a claims professional to investigate, evaluate, and resolve high‑complexity Workers' Compensation claims. You will independently manage assignments to achieve legitimate outcomes in line with statutes, policy provisions, and company guidelines.

Responsibilities include reserving, coverage and compensability determinations, settlements, medical and return‑to‑work coordination, and effective communication with clients.

Qualifications

• Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry.
• At least 3-5 years' experience handling lost time workers compensation claims; NC, SC, and MS jurisdiction experience required.
• Associate in Claims (AIC) Designation or similar professional designation desired.
• Active license required or ability to obtain license within 90 days of employment in mandated states.
• Familiarity with medical terminology and/or Workers' Compensation.
• Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously.
• Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details.
• Strong verbal, written communication skills and customer service skills.
• Travel for business purposes is approximately less than 10%.

Responsibilities

• Investigate assigned claims with minimal supervision, including complex cases.
• Determine coverage, compensability, subrogation potential, and second injury fund where applicable.
• Alert Supervisor and Special Investigations Unit to potentially suspect claims.
• Ensure timely denial or payment of benefits per jurisdictional requirements.
• Establish and adjust reserves with documented rationale; maintain reserves over the life of the claim.
• Negotiate settlements with client approval.
• Develop action plans for case resolution including medical and disability management; litigation management as needed.
• Collaborate with PMA nurse professionals to implement return to work strategies.
• Select and manage service vendors to balance expense and loss outcomes.
• Maintain knowledge of jurisdictional requirements and applicable case law for each state serviced.
• Communicate effectively with internal and external parties on a wide variety of claims and account issues.
• Provide a high degree of customer service during reviews, stewardship meetings, and account-specific sessions.
• Authorize treatment per protocols established by statute or PMA Managed Care.
• Assist PMA clients by suggesting panel provider information in accordance with state statutes.

Skills

Attention to detail

Investigative skills

Analytical thinking

Organizational skills

Verbal communication

Written communication

MS Office

Education

Bachelor's degree or equivalent

Tools

MS Office

Job description

Old Republic Commercial Risk is seeking a claims professional to investigate, evaluate, and resolve high‑complexity Workers' Compensation claims. You will independently manage assignments to achieve legitimate outcomes in line with statutes, policy provisions, and company guidelines.

Responsibilities include reserving, coverage and compensability determinations, settlements, medical and return‑to‑work coordination, and effective communication with clients.