Senior Workers' Comp Claims Strategist

Old Republic Commercial Risk; Jackson (MS); On-site; USD 65,000 - 90,000; Full time

Job summary

Old Republic Commercial Risk is seeking an experienced claims professional to independently investigate and resolve high‑complexity workers’ compensation claims. You will assess coverage, subrogation potential, and reserves while adhering to statutes and company policies.

Responsibilities include timely denial or payment decisions, settlements with client approval, and coordinating with PMA nurses on return‑to‑work strategies. Strong communication and organizational skills are essential.

Qualifications

• Bachelor's degree or four+ years in insurance-related work experience.
• 3-5 years' experience handling lost time workers' compensation claims; MS/NC/MS jurisdiction experience.
• Active license required or ability to obtain license within 90 days in mandated states.
• Familiarity with medical terminology and/or Workers' Compensation.
• Strong organizational skills with ability to work independently on multiple tasks.
• Proven critical thinking, judgment and attention to detail; strong communication and customer service skills.
• Computer literacy, including MS Office (Word, Excel, PowerPoint).

Responsibilities

• Promptly investigate all assigned claims with minimal supervision, including complex cases.
• Determine coverage, compensability, potential for subrogation, and second injury fund when applicable.
• Alert Supervisor and Special Investigations Unit to potentially suspect claims.
• Ensure timely denial or payment of benefits per jurisdictional requirements.
• Establish reserves with documented rationale and adjust over the life of the claim.
• Negotiate claims settlements with client approval.
• Develop action plans for case resolution including medical and disability management, litigation, negotiation.
• 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 for each state.
• Demonstrate proficient execution of best claim practices.
• Communicate effectively with internal and external parties on claims and account issues.
• Provide high level of customer service during reviews and account sessions.
• Authorize treatment per protocols established by statute or PMA Managed Care.
• Assist PMA clients with panel provider information as per state statutes.
• Adhere to Company Code of Business Conduct and Ethics and compliance policies.

Skills

Organizational skills

Critical thinking

Verbal communication

Written communication

Customer service

Education

Bachelor's degree or four+ years in insurance related field

AIC designation

Active license in mandated states or ability within 90 days

Tools

MS Office

Job description

Old Republic Commercial Risk is seeking an experienced claims professional to independently investigate and resolve high‑complexity workers’ compensation claims. You will assess coverage, subrogation potential, and reserves while adhering to statutes and company policies.

Responsibilities include timely denial or payment decisions, settlements with client approval, and coordinating with PMA nurses on return‑to‑work strategies. Strong communication and organizational skills are essential.