WC Claims Representative - South/West Team -Charlotte, NC (Hybrid)

Selective Insurance Company of America•Charlotte, NC

1d•Hybrid

About The Position

Selective Insurance is seeking a Workers Compensation Claims Representative to handle claims for the South/West region. The role involves communicating effectively and promptly with employers, employees, and medical providers; investigating lost-time claims to determine coverage and compensability under jurisdictional guidelines; gathering information for thorough investigations; establishing claim facts and making timely decisions; partnering with nurse management to support injured workers’ return to gainful employment; managing benefits and claim resolution; and providing compelling customer service. All duties must be performed in compliance with applicable legal and regulatory requirements.

Requirements

Knowledge of workers’ compensation statutes, coverage, and case law.
Excellent written and verbal communication skills.
Working knowledge of medical treatment and terminology related to medical-only workers’ compensation claims.
Critical-thinking skills to assess claim compensability in light of the facts and applicable law.
Experience handling claims in the South/West region.

Nice To Haves

College degree preferred.
One to three years of claims experience preferred.

Responsibilities

Investigate assigned lost-time claims to determine coverage and compensability, primarily for claims with a disability period of eight weeks or less, though some may exceed that period.
Process claims by making contacts, establishing claim files in MCS, evaluating exposure, setting initial and subsequent reserves on less severe claims, and analyzing investigative information.
Make timely payments and manage claims through resolution.
Document claim files and maintain work control through documentation or a diary system.
Handle non-litigated and litigated claims.
File state forms promptly in accordance with statutory guidelines.
Collaborate with nurses and vendors on medical and disability management.
Prepare for and participate in claims reviews and settlement conferences.
Ensure compliance with company, state, and federal regulations.
Communicate effectively and promptly with employers, employees, and medical providers.
Partner with nurse management to help return injured workers to gainful employment when appropriate.
Manage administration of benefits and claim resolution while providing customer service.