Senior Workers' Comp Claims Specialist (Complex Cases)

Old Republic Commercial Risk; Raleigh (NC); On-site; < USD 1; Full time

Job summary

Old Republic Commercial Risk in Raleigh, NC seeks a seasoned claims professional to independently investigate, evaluate, and resolve high-risk workers' compensation claims. You will administer and resolve complex claims in line with statutes, policy provisions, and company guidelines.

Responsibilities include determining coverage and compensability, managing reserves, negotiating settlements, and coordinating with PMA nurses on return-to-work plans. Travel is required occasionally.

Qualifications

• Bachelor's degree or equivalent experience in insurance is required.
• 3-5 years' experience handling lost time workers' compensation claims is required; NC, SC and MS jurisdiction experience is required.
• Active license in mandated states or ability to obtain within 90 days.

Responsibilities

• Investigate and resolve assigned workers' compensation claims with minimal supervision.
• Determine coverage, compensability, subrogation potential, and second injury fund applicability.
• Maintain appropriate reserves and adjust over the life of the claim.
• Negotiate settlements with client approval and communicate effectively with stakeholders.
• Collaborate with PMA nurse professionals on return-to-work strategies and case management.
• Travel for business purposes as needed (less than 10%).

Skills

Organizational skills

Critical thinking

Verbal communication

Written communication

Customer service

Education

Bachelor's degree or equivalent work experience in insurance

Tools

MS Office

Job description

Old Republic Commercial Risk in Raleigh, NC seeks a seasoned claims professional to independently investigate, evaluate, and resolve high-risk workers' compensation claims. You will administer and resolve complex claims in line with statutes, policy provisions, and company guidelines.

Responsibilities include determining coverage and compensability, managing reserves, negotiating settlements, and coordinating with PMA nurses on return-to-work plans. Travel is required occasionally.