Senior Workers' Comp Claims Specialist - Complex Claims

Old Republic Commercial Risk; Wilmington (NC); On-site; USD 60,000 - 90,000; Full time

Job summary

Old Republic Commercial Risk is seeking an experienced claims professional to investigate, evaluate, and resolve high-complexity workers' compensation claims. You will handle coverage, compensability, and subrogation while ensuring timely decisions and reserves are set with documented rationale.

In this role you will negotiate settlements, collaborate with PMA nurses on return-to-work strategies, and manage vendor relationships to balance costs with outcomes.

Qualifications

• Bachelor's degree or four+ years in insurance industry experience.
• Experience handling workers' compensation claims, including NC/SC/MS jurisdictions.
• Active license or ability to obtain within 90 days in required states.
• Familiarity with medical terminology and workers' compensation processes.

Responsibilities

• Investigate and resolve high complexity claims with minimal supervision.
• Determine coverage, compensability, and potential subrogation.
• Manage reserves and negotiate settlements with client approval.
• Collaborate with PMA nurses on return-to-work strategies and case plans.
• Liaise with vendors, provide communication to internal/external parties.
• Maintain knowledge of jurisdictional requirements and case law.

Skills

Strong communication

Organizational skills

Critical thinking

Customer service

Attention to detail

Travel readiness

Education

Bachelor's degree or equivalent experience

Tools

MS Office

MS Word

MS Excel

Job description

Old Republic Commercial Risk is seeking an experienced claims professional to investigate, evaluate, and resolve high-complexity workers' compensation claims. You will handle coverage, compensability, and subrogation while ensuring timely decisions and reserves are set with documented rationale.

In this role you will negotiate settlements, collaborate with PMA nurses on return-to-work strategies, and manage vendor relationships to balance costs with outcomes.