Claims Specialist II, Workers Compensation (NE Region)

Zurich Insurance Group•Boston, NJ

18d•Hybrid

About The Position

Zurich is seeking a Workers Compensation Claims Specialist II to handle multi-party commercial workers’ compensation claims of low to high exposure and complexity within specified authority limits. The role focuses on efficient, effective claim handling and customer-centric service. It offers a hybrid schedule from the Parsippany or Boston offices, or a fully remote arrangement for candidates based in Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, or West Virginia. The specialist documents and evaluates claims, determines liability and coverage, develops strategies for timely resolution, establishes and reviews reserves, assesses damages, and negotiates settlements within authority limits. The role also includes maintaining quality and legal compliance, communicating proactively with customers, managing vendors and expenses, identifying potential subrogation and fraud, sharing risk insights, protecting confidential information, and maintaining professional knowledge. The position requires a qualifying combination of education and Claims or Insurance experience, as well as required adjuster licenses. The national proposed salary range is $59,900 to $98,200, with eligibility for a 10% short-term incentive bonus. Compensation may vary by location, skills, and experience.

Requirements

Bachelor’s degree and at least 3 years of experience in Claims or Insurance; OR Zurich Certified Insurance Apprentice, including an associate degree, and at least 3 years of experience in Claims or Insurance; OR completion of the Zurich Claims Training Program and at least 2 years of experience in Claims or Insurance; OR high school diploma or equivalent and at least 5 years of experience in Claims or Insurance.
Must obtain and maintain required adjuster license(s).
Knowledge of insurance regulations, markets, and products.
Experience with Microsoft Office.

Nice To Haves

At least 4 years of experience in the Workers Compensation line of business.
At least 3 years of experience handling litigation management.
Specialization in Massachusetts, Maine, and Vermont jurisdictions, with knowledge of Connecticut and New Hampshire.
Familiarity with the Subsequent Injury Fund in Massachusetts.
Ability to learn and handle additional jurisdictions as needed.
Knowledge of EDI filing requirements.
MSA/Medicare knowledge.
WCCA or WCCP designations.
Knowledge and skill in claims handling.
Negotiation experience.
Experience in the relevant line of business.
Excellent communication skills.
Analytical skills.

Responsibilities

Document claims files by accurately capturing and updating claims data and information in accordance with best practices.
Determine liability by gathering and analyzing relevant facts, applying applicable law, and establishing basic negligence principles.
Verify policies and determine coverage by analyzing applicable coverage and whether losses fall within it.
Develop case strategies and evaluations, escalate issues as appropriate, and work toward timely claim resolution.
Establish timely reserves and review them throughout the claims cycle by estimating and validating claim values within authority limits.
Assess damages by calculating applicable damages or ranges allowed by law.
Negotiate claim settlements by establishing strategies and using available tools and resources within authority limits.
Meet quality standards by following best practices.
Provide customer service by communicating proactively, responding to inquiries, following customer protocols, and potentially participating in customer marketing efforts.
Manage expenses by using approved vendor networks and managing the scope of work assigned to outside contractors; depart from approved vendors with manager approval when it is in the insured’s best interests.
Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
Refer claims to subrogation and fraud teams when potential subrogation or fraud is identified.
Contribute to profitable growth by providing risk insights, information, and trends to the Business Unit or customers as needed.
Protect Zurich’s reputation by maintaining the confidentiality of claims information.
Maintain professional and technical knowledge through educational opportunities, monitoring industry trends, building professional networks, and participating in professional societies.