Senior Workers' Comp Claims Strategist

Old Republic Commercial Risk; Camp Hill (Cumberland County); Sur place; USD 60 000 - 80 000; Plein temps

Résumé du poste

Old Republic Commercial Risk is seeking a claims professional in Camp Hill, PA to independently investigate and resolve complex workers' compensation claims, ensuring outcomes align with statutes and policy provisions.

You will determine coverage, reserves, and potential subrogation, and negotiate settlements while coordinating with PMA nurses for return-to-work strategies and managing vendors to balance cost and loss outcomes.

Qualifications

• Bachelor's degree or four+ years in insurance-related work.
• 3–5 years' experience handling lost-time workers' compensation claims.
• Active license or ability to obtain within 90 days in mandated states.
• Familiarity with medical terminology and Workers' Compensation.
• Strong organizational skills with the ability to work independently and multitask.
• Proficiency in MS Office (Word, Excel, PowerPoint).
• Willingness to travel up to 10% for business.

Responsabilités

• Investigate assigned claims with minimal supervision, including complex cases.
• Determine coverage, compensability, subrogation potential, and second injury fund when applicable.
• Alert Supervisor and SIU to potentially suspect claims.
• Ensure timely denial or payment of benefits per jurisdiction requirements.
• Establish reserves with documented rationale and adjust over the life of the claim.
• Negotiate settlements with client approval.
• Develop and implement action plans for case resolution, including medical and disability management.
• Collaborate with PMA nurses to implement return-to-work strategies.
• Select and manage service vendors to balance expenses and loss outcomes.
• Maintain knowledge of jurisdictional requirements and applicable case law.
• Demonstrate proficiency through timely execution of best claim practices.
• Communicate effectively with internal and external parties on claims and account issues.
• Provide high-level customer service during reviews, stewardship meetings, and sessions.

Connaissances

Analytical thinking

Attention to detail

Communication skills

Organizational skills

Travel willingness

Formation

Bachelor's degree or equivalent experience

Outils

MS Office

Description du poste

Old Republic Commercial Risk is seeking a claims professional in Camp Hill, PA to independently investigate and resolve complex workers' compensation claims, ensuring outcomes align with statutes and policy provisions.

You will determine coverage, reserves, and potential subrogation, and negotiate settlements while coordinating with PMA nurses for return-to-work strategies and managing vendors to balance cost and loss outcomes.