Workers' Comp Claims Specialist — Growth & Impact

Zenith Insurance Company (United States); Virginia (IL); On-site; USD 74,000 - 93,000; Full time

Benefits offered by this job

Medical/Dental/Vision Insurance

401(k) Plan

Education Reimbursement

Paid Holidays

Personal Days

Floating Holidays

Employee Assistance Program

Job summary

Zenith Insurance Company seeks an experienced claims professional to investigate, analyze, and determine liability on claims, and to negotiate settlements when appropriate. The role involves interviewing medical specialists, agents, witnesses, or claimants to gather information and to calculate and approve payments within authority.

The position requires opening new claims, setting reserves, and maintaining data integrity.

Qualifications

• Basic technical workers’ compensation Claims knowledge.
• Strong verbal and written communication skills with emphasis on telephone communication required.
• Strong math and reading skills required.
• Meets all state regulatory standards regarding licensing, continuing education, and other requirements.

Responsibilities

• Under technical direction, works within significant limits and authority on assignments of higher technical complexity and coordination.
• Responsible for Claims management of assigned cases within guidelines of published performance standards.
• Opens new Claims, completes three-point contact, and performs needed investigations to determine compensability as well as possible subrogation or apportionment, according to state and/or Zenith’s timeframes and guidelines.
• Sets appropriate reserves according to Zenith’s timeframes and guidelines.
• Follows appropriate procedures for system documentation to preserve data integrity.
• Monitors and maintains accuracy of reserves over the life of the claim; when new information is received re-evaluates and recommends reserves according to Zenith’s standards.
• Creates and executes action plans needed to bring case to closure.
• Completes detailed settlement evaluations and recommends appropriate settlement value, within authority; negotiates claim settlements with injured workers and/or injured workers’ attorneys.
• Maintains regular contact with injured workers, employers and agents to develop positive relationships and establish credibility.
• Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
• Works productively and harmoniously with others on a consistence basis.
• Respond positively to direction and criticism of performance.
• Consistently maintain professional and appropriate demeanor.

Skills

Claims knowledge

Verbal communication

Written communication

Math skills

Reading skills

Regulatory compliance

Education

High School Diploma or equivalent

Bachelor’s degree or equivalent

Job description

Zenith Insurance Company seeks an experienced claims professional to investigate, analyze, and determine liability on claims, and to negotiate settlements when appropriate. The role involves interviewing medical specialists, agents, witnesses, or claimants to gather information and to calculate and approve payments within authority.

The position requires opening new claims, setting reserves, and maintaining data integrity.