WC Complex Med Only Adjuster - Charlotte, NC (Hybrid)

Selective Insurance Company of America; Charlotte (NC); Hybrid; USD 53,000 - 68,000; Full time

Benefits offered by this job

Health care plans

Retirement plan with company match

Employee Stock Purchase Program

Tuition assistance

20 days PTO

Job summary

Selective Insurance is seeking a WC Complex Med Only Adjuster for our Charlotte, NC office on a hybrid schedule. Experience handling claims in NC and surrounding states is preferred.

You will investigate medical only claims, determine coverage and subrogation potential, manage reserves, and provide strong customer service while complying with regulatory requirements.

Qualifications

• Knowledge of workers compensation statutes, coverage, and case law.
• Excellent written and verbal communication skills.
• Understanding medical terminology related to medical only workers compensation.

Responsibilities

• Receives assigned complex medical only claims for investigation through telephone or written communication with insureds, claimants, and providers to determine coverage, compensability, subrogation potential, and appropriate course of action.
• Handles mostly non-indemnity claims (no lost time within waiting period), medical causality, denied claims (not compensable and not covered), and medical claim petitions. On occasion will manage claims with minimal permanency benefits (indemnity). Establishes initial and subsequent reserves on complex medical only claims with a general exposure of less than $30,000.
• Processes claims which include the following activities: Making contacts, setting reserves, evaluating claims for exposure, establishing timely reserve adjustments during the life of the file, making timely payments, and resolution.
• Documents claim files and maintain control of work through documentation or diary system.
• Manages medical only claims with some complexity that may require a nurse consult, diagnostics, and minor medical procedures. Understand medical terminology and injury mechanism. Ability to recognize comorbidities that may complicate injury and recovery.
• File state forms timely in accordance with statutory guidelines.
• Ensures compliance with company, state, and federal regulations. Makes certain data is accurate and updated timely for electronic data interchange with state and Medicare.
• Handle disputed facts, benefits, compensability, coverage, medical causality, and relatedness.
• Receives assigned claims from the medical only unit , notice of loss coordinator, or lost time adjusters.

Skills

WC knowledge

Communication skills

Medical terminology

Critical thinking

Education

College degree preferred

Job description

About Us

At Selective, we don't just insure uniquely, we employ uniqueness.

Selective is a midsized U.S. domestic property and casualty insurance company with a history of strong, consistent financial performance for nearly 100 years. Selective's unique position as both a leading insurance group and an employer of choice is recognized in a wide variety of awards and honors, including listing in Forbes Best Midsize Employers in 2025 and certification as a Great Place to Work® in 2025 for the sixth consecutive year.

Employees are empowered and encouraged to Be Uniquely You by being their true, unique selves and contributing their diverse talents, experiences, and perspectives to our shared success. Together, we are a high-performing team working to serve our customers responsibly by helping to mitigate loss, keep them safe, and restore their lives and businesses after an insured loss occurs.

Overview

Selective Insurance is seeking a WC Complex Med Only Adjuster for our Charlotte, NC office on a hybrid schedule. Experience handling claims in NC, SC, GA, KY, TN, VA, AZ, CO, UT preferred.

Responsibility includes effective and timely communication with employer, employee, and medical provider. Investigate medical only claims to determine coverage, compensability, and subrogation potential based on jurisdictional guidelines. Manage claims in multiple jurisdictions. Continuous review and analysis of these claims to ensure that the reserves are appropriate. Manage administration of benefits and claim resolution. Obtain relevant information necessary for a thorough investigation. Freeze facts of claims and make timely decisions. Provide compelling customer service. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.

Responsibilities

• Receives assigned complex medical only claims for investigation through telephone or written communication with insureds, claimants, and providers to determine coverage, compensability, subrogation potential, and appropriate course of action.
• Handles mostly non-indemnity claims (no lost time within waiting period), medical causality, denied claims (not compensable and not covered), and medical claim petitions. On occasion will manage claims with minimal permancy benefits (indemnity). Establishes initial and subsequent reserves on complex medical only claims with a general exposure of less than $30,000.
• Processes claims which include the following activities: Making contacts, setting reserves, evaluating claims for exposure, establishing timely reserve adjustments during the life of the file, making timely payments, and resolution.
• Documents claim files and maintain control of work through documentation or diary system.
• Manages medical only claims with some complexity that may require a nurse consult, diagnostics, and minor medical procedures. Understand medical terminology and injury mechanism. Ability to recognize comorbidities that may complicate injury and recovery.
• File state forms timely in accordance with statutory guidelines.
• Ensures compliance with company, state, and federal regulations. Makes certain data is accurate and updated timely for electronic data interchange with state and Medicare.
• Handle disputed facts, benefits, compensability, coverage, medical causality, and relatedness.
• Receives assigned claims from the medical only unit , notice of loss coordinator, or lost time adjusters.

Qualifications

Knowledge and Requirements

• Knowledge of workers compensation statutes, coverage, and case law. Excellent written and verbal communication skills.
• Working knowledge of medical treatment and terms as related to medical only workers compensation claims.
• Critical thinking skills to assess compensability of WC claim as it relates to the facts and law.

Education and Experience

• College degree preferred.
• 1-3 years claims experience preferred.
• Experience handling claims in NC, SC, GA, KY, TN, VA, AZ, CO, UT is preferred.

Total Rewards

Selective Insurance offers a total rewards package that includes a competitive base salary, incentive plan eligibility at all levels, and a wide array of benefits designed to help you and your family stay healthy, achieve your financial goals, and balance the demands of your work and personal life.

• Comprehensive health care plans
• Retirement savings plan with company match
• Discounted Employee Stock Purchase Program
• Tuition assistance and reimbursement programs
• 20 days of paid time off

Additional details about our total rewards package can be found by visiting our benefits page.

The actual base salary is based on geographic location, and the range is representative of salaries for this role throughout Selective's footprint. Additional considerations include relevant education, qualifications, experience, skills, performance, and business needs.

Pay Range

USD $53,000.00 - USD $68,000.00 /Yr.

Additional Information

Selective is an Equal Employment Opportunity employer. That means we respect and value every individual’s unique opinions, beliefs, abilities, and perspectives. We are committed to promoting a welcoming culture that celebrates diverse talent, individual identity, different points of view and experiences – and empowers employees to contribute new ideas that support our continued and growing success. Building a highly engaged team is one of our core strategic imperatives, which we believe is enhanced by diversity, equity, and inclusion. We expect and encourage all employees and all of our business partners to embrace, practice, and monitor the attitudes, values, and goals of acceptance; address biases; and foster diversity of viewpoints and opinions.

For Massachusetts Applicants

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.