Workers' Comp Claims Specialist - Heartland Region

Selective Insurance Company of America; Charlotte (NC); On-site; USD 60,000 - 78,000; Full time

Job summary

Selective Insurance is seeking a Workers' Comp Claim Rep to handle claims for the Heartland Region (IA, IN, IL, KS, MI, MN, MO, WI). Responsibilities include investigating claims, determining coverage, and coordinating with providers and nurses to return injured workers to work.

The role requires knowledge of WC statutes, strong communication, and the ability to manage both medicolegal aspects and administrative duties in a regulated environment.

Qualifications

• Knowledge of workers' compensation statutes and case law.
• Excellent written and verbal communication skills.
• Working knowledge of medical treatment and terms related to WC claims.

Responsibilities

• Receives assigned lost time claims for investigation to determine coverage and compensability within 8 weeks.
• Processes claims including contacts, reserves, file setup, evaluating exposure, and initial reserves.
• Documents claim files and maintains control of work through the diary system.
• Handle non-litigated and litigated claims.
• File state forms timely per statutory guidelines.
• Collaborate with nurses and vendors on medical and disability management.
• Prepare for and participate in claims review and settlement conferences.
• Ensure compliance with company, state, and federal regulations.

Skills

Workers' comp knowledge

Excellent communication

Analytical thinking

Education

College degree preferred

1-3 years claims experience preferred

Job description

Selective Insurance is seeking a Workers' Comp Claim Rep to handle claims for the Heartland Region (IA, IN, IL, KS, MI, MN, MO, WI). Responsibilities include investigating claims, determining coverage, and coordinating with providers and nurses to return injured workers to work.

The role requires knowledge of WC statutes, strong communication, and the ability to manage both medicolegal aspects and administrative duties in a regulated environment.