Senior Workers' Comp Claims Strategist

Old Republic Commercial Risk; Charleston (SC); On-site; USD 70,000 - 100,000; Full time

Job summary

Old Republic Commercial Risk in Charleston, SC seeks a seasoned claims professional to independently investigate, evaluate, and resolve high-complexity workers' compensation claims.

You will collaborate with PMA nurses, determine coverage and subrogation potential, manage reserves, and negotiate settlements while ensuring compliance with state statutes and company guidelines.

Travel up to 10% may be required.

Qualifications

• Bachelor's degree or 4+ years of equivalent work experience in insurance required.
• 3-5 years' experience handling lost time workers' compensation claims; NC, SC and MS jurisdiction experience preferred.
• AIC designation or similar professional designation desired.
• Active license required or ability to obtain within 90 days in mandated states.
• Familiarity with medical terminology and Workers' Compensation.

Responsibilities

• Investigate assigned claims with minimal supervision, including complex ones.
• Determine coverage, compensability, potential subrogation, and second injury fund eligibility.
• Alert Supervisor and SIU to potentially suspect claims.
• Ensure timely denial or payment of benefits per jurisdictional requirements.
• Establish reserves with 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 on return-to-work strategies.
• Select and manage service vendors to balance expenses and outcomes.
• Maintain knowledge of state requirements and applicable case law.
• Communicate effectively with internal and external parties.

Skills

Organizational skills

Critical thinking

Verbal communication

Written communication

Customer service

Education

Bachelor's degree or 4+ years experience

AIC designation

Tools

MS Office

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Old Republic Commercial Risk in Charleston, SC seeks a seasoned claims professional to independently investigate, evaluate, and resolve high-complexity workers' compensation claims.

You will collaborate with PMA nurses, determine coverage and subrogation potential, manage reserves, and negotiate settlements while ensuring compliance with state statutes and company guidelines.

Travel up to 10% may be required.