Senior Workers’ Comp Claims Strategist

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

Job summary

Old Republic Commercial Risk is seeking an experienced claims professional specialized in Workers' Compensation to independently investigate, evaluate, and resolve complex claims. You will administer and resolve high-risk claims in a timely manner in accordance with statutes, policy provisions, and company guidelines.

Responsibilities include investigating claims, determining coverage and compensability, negotiating settlements, and coordinating with medical professionals to manage

Qualifications

• Bachelor's degree or four or more years of equivalent work experience in an insurance related industry.
• Strong organizational, analytical and multitasking abilities.
• Excellent verbal and written communication skills.

Responsibilities

• Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature
• Determine coverage, compensability, subrogation potential, 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 rationale and adjust over the life of the claim
• Negotiate settlements with client approval
• Develop action plans for case resolution including medical and disability management, litigation, and disposition
• Collaborate with PMA nurse professionals on return to work strategies
• Select and manage service vendors to balance expense and outcomes
• Maintain knowledge of jurisdictional requirements and case law for each state served
• Demonstrate best claim practices with timely execution
• Communicate effectively with internal and external parties on claims and account issues
• Provide high level of customer service during reviews and meetings
• Authorize treatment per PMA protocols
• Suggest panel provider information per state statutes
• Adhere to Code of Business Conduct and applicable laws

Skills

Organizational skills

Critical thinking

Verbal communication

Written communication

Customer service

MS Office proficiency

Education

Bachelor's degree or equivalent experience in insurance

Tools

MS Office

Job description

Old Republic Commercial Risk is seeking an experienced claims professional specialized in Workers' Compensation to independently investigate, evaluate, and resolve complex claims. You will administer and resolve high-risk claims in a timely manner in accordance with statutes, policy provisions, and company guidelines.

Responsibilities include investigating claims, determining coverage and compensability, negotiating settlements, and coordinating with medical professionals to manage