Workers' Compensation Claims Representative II - Litigated Claims
About The Position
The Workers' Compensation Claims Representative II manages a multi-state caseload of complex lost-time and litigated workers' compensation claims from investigation through resolution. The role involves making well-supported compensability decisions, developing claim strategies, evaluating evidence, maintaining appropriate reserves, managing litigation with external partners, and administering benefits and regulatory filings. The representative independently manages a high-volume caseload while meeting quality, compliance, productivity, and resolution expectations. The role may be based at the company's Scottsdale, Arizona office and follows a hybrid schedule of two remote days and three in-office days.
Requirements
- At least 3 years of experience handling complex, litigated lost-time workers' compensation claims, including demonstrated Nevada claims-handling experience.
- Experience handling multi-state workers' compensation claims.
- Active Nevada adjuster license and ability to obtain and maintain other required state licenses.
- Experience working with defense counsel, medical providers, and other external claim partners.
- Strong knowledge of workers' compensation claim investigation, compensability, reserving, litigation management, and resolution strategies.
- Ability to manage a high-volume caseload while meeting regulatory and service deadlines.
- Strong written and verbal communication, organization, and time-management skills.
Nice To Haves
- Experience with California, Colorado, and/or Arizona workers' compensation claims.
- Bachelor's degree or an equivalent combination of education and relevant experience.
Responsibilities
- Manage a caseload of complex lost-time and litigated workers' compensation claims.
- Investigate claims and make timely, well-supported compensability decisions.
- Develop claim strategies focused on appropriate outcomes, settlement opportunities, and timely claim closure.
- Evaluate medical documentation, legal filings, wage information, and other claim-related evidence.
- Establish and maintain appropriate reserves based on anticipated claim exposure.
- Manage litigated claims in partnership with defense counsel, medical providers, investigators, and other external partners.
- Administer indemnity benefits, wage calculations, payments, and required state filings in accordance with applicable workers' compensation regulations.
- Identify potential fraud indicators, litigation exposure, and other claim risks and develop appropriate action plans.
- Provide responsive, professional service to injured workers, employers, attorneys, medical providers, and other stakeholders.
- Independently manage a high-volume caseload while meeting expectations for quality, compliance, productivity, and claim resolution.
Benefits
- Competitive pay
- Generous paid time off
- Medical, dental, and vision coverage starting on day one
- 401(k)
- Tuition reimbursement
- Longevity bonuses
- Support for required licensing costs, training, and continuing education
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
