Sr. Workers Comp Claims Rep (Hybrid/Remote)
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About The Position
Selective Insurance is seeking a Senior Workers Compensation Claims Representative for our Charlotte, NC office, with the possibility of remote work for the ideal candidate residing outside of NC and SC. This role is pivotal in managing lost-time claims, specifically those with a disability period exceeding 10 weeks. The successful candidate will be responsible for investigating claims to determine coverage and compensability based on jurisdictional guidelines. This includes obtaining relevant information necessary for thorough investigations, freezing the facts of claims, and making timely decisions. The position requires effective collaboration with nurse management to facilitate the return of injured workers to gainful employment when necessary, as well as managing litigation in collaboration with Staff and Panel Counsel. The Senior Workers Compensation Claims Representative will also oversee the administration of benefits and claim resolution, ensuring compelling customer service through effective and timely communication with employers, employees, and medical providers. Responsibilities include processing claims, setting reserves, evaluating exposure, and establishing initial and subsequent reserves on claims with an exposure greater than $25,000. The role demands a critical understanding of workers compensation statutes, coverage, and case law, along with excellent written and verbal communication skills. The ideal candidate will possess critical thinking skills to assess the compensability of claims in relation to the facts and law, and will be expected to document claims files meticulously while maintaining control of work through a documentation or diary system. Compliance with company, state, and federal regulations is essential, as is the ability to prepare for and participate in claims review and settlement conferences.
