Workers Compensation Claims Specialist (NE Region)

Zurich Insurance Group•Boston, NH

6d•Hybrid

About The Position

Zurich is seeking an accomplished Workers Compensation Claims Specialist II for its Northeast region. This role involves handling multi-party commercial line Workman’s Compensation claims of low to high exposure and complexity within specific authority limits. The goal is to ensure claims are managed efficiently and effectively, providing a customer-centric claims service. The position offers a hybrid work schedule from our Parsippany or Boston offices, or a fully remote setup for candidates located in Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, or West Virginia.

Requirements

Bachelor’s Degree and 3 or more years of experience in the Claims or Insurance area OR Zurich Certified Insurance Apprentice, including an Associate Degree and 3 or more years of experience in Claims or Insurance area OR Completion of Zurich Claims Training Program and 2 or more years of experience in the Claims or Insurance area OR High School Diploma or Equivalent and 5 or more years of experience in the Claims or Insurance area
Must obtain and maintain required adjuster license(s)
Knowledge of insurance regulations, markets and products
Microsoft Office experience

Nice To Haves

4+ years of experience in the Workers Compensation line of business
3+ years of experience handling litigation management
Specialization in PA jurisdiction with knowledge of NJ and/or VA jurisdictions
Learn and handle additional jurisdictions as needed
EDI filing requirements
MSA/Medicare knowledge
WCCA, WCCP Designations
Knowledge and skill of claims handling
Negotiation experience
Experience in line of business
Excellent communication skills
Analytical skills

Responsibilities

Document claims file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate exposure and complexity personal or commercial line claims.
Exercise judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.
Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.
Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
Assess damages by calculating applicable damages or range of damages allowed by law.
Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
Meet quality standards by following best practices.
Ensure customer service by proactively communicating information; responding to inquiries; following customer protocols and may participating in customer marketing efforts.
Manage expenses by working within vendor approved networks and managing scope of work assigned to outside contractors. Departs from approved vendors with manager approval, where in the best interests of the insured.
Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
Refer claim to subrogation and fraud teams by identifying potential subrogation and fraud.
Contribute to profitable growth by providing risk insight, information and trends to Business Unit or customer as needed.
Protect Zurich’s reputation by keeping claims information confidential.
Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.