Strategic Workers' Compensation Claims Specialist

Old Republic Commercial Risk; Little Rock (AR); On-site; USD 65,000 - 90,000; Full time

Job summary

Old Republic Commercial Risk is seeking a Claims professional to independently investigate, evaluate and resolve complex Workers' Compensation claims, ensuring timely outcomes in accordance with statutes, policy provisions and company guidelines.

You will determine coverage, compensability and subrogation potential, establish reserves with rationale, negotiate settlements, and coordinate return-to-work strategies with PMA nurses.

Qualifications

• Bachelor's degree and/or 4+ years in insurance required.
• TX licensure required or must be obtained within 90 days.
• Experience handling workers' compensation claims in AR/OK/CO/LA preferred.

Responsibilities

• Investigate assigned claims with minimal supervision, including complex ones.
• Determine coverage, compensability, and subrogation potential.
• Alert supervisors to potentially suspect claims.
• Ensure timely denial or payment of benefits per jurisdiction.
• Establish and adjust reserves with documented rationale.
• Negotiate settlements within granted authority.
• Develop 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 costs and outcomes.
• Maintain knowledge of state requirements and applicable case law.
• Communicate effectively with internal and external parties.
• Provide high-level customer service during reviews and sessions.
• Authorize treatment per PMA protocols.
• Assist PMA clients with panel provider info per statutes.

Skills

Organizational skills

Critical thinking

Verbal and written communication

Customer service

Education

Bachelor's degree

AIC designation

Tools

MS Office

Job description

Old Republic Commercial Risk is seeking a Claims professional to independently investigate, evaluate and resolve complex Workers' Compensation claims, ensuring timely outcomes in accordance with statutes, policy provisions and company guidelines.

You will determine coverage, compensability and subrogation potential, establish reserves with rationale, negotiate settlements, and coordinate return-to-work strategies with PMA nurses.