Senior Workers' Comp Claims Specialist - Hybrid

Selective; Charlotte, Northern (NC, KY); Hybrid; USD 69,000 - 89,000; Full time

Benefits offered by this job

Health insurance

401(k) with company match

Employee stock purchase program

Tuition assistance

20 days paid time off

Job summary

Selective Insurance is seeking a Senior Workers' Compensation Claims Representative for its Charlotte, NC office. This hybrid role blends in-office collaboration with remote work, requiring effective communication with employers, employees, and medical providers, and thorough investigation of lost time claims.

You will manage claims from investigation to resolution, coordinate with nurses and counsel, ensure regulatory compliance, and deliver strong customer service while targeting timely

Qualifications

• Knowledge of workers' compensation statutes, coverage, and case law.
• Excellent written and verbal communication skills.
• Working knowledge of medical treatment and terms 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 disability period greater than 10 weeks.
• Processes claims including contacts, setting reserves, evaluating exposure, and establishing initial and subsequent reserves on claims with exposure >$100,000; analyzes investigational data and pursues timely payments to resolution.
• Handles both non-litigated and litigated cases.
• Collaborates with nurses and vendors on medical and disability management; collaborates with Staff/Panel Counsel on litigated cases.
• Documents claims files and maintains control of work through a diary system.
• Addresses disputed facts, benefits, compensability, coverage, medical causality, and relatedness.
• Filing state forms timely per statutory guidelines.
• Prepare for and participate in claims review and settlement conferences.
• Ensure compliance with company, state, and federal regulations.

Skills

Knowledge of WC statutes

Communication skills

Medical terminology

Critical thinking

Education

College degree preferred

3-5 years claims experience preferred

Job description

Selective Insurance is seeking a Senior Workers' Compensation Claims Representative for its Charlotte, NC office. This hybrid role blends in-office collaboration with remote work, requiring effective communication with employers, employees, and medical providers, and thorough investigation of lost time claims.

You will manage claims from investigation to resolution, coordinate with nurses and counsel, ensure regulatory compliance, and deliver strong customer service while targeting timely