Workers' Compensation Claims Specialist

Zenith Jobs•East Norriton, PA

7d•$76,525 - $86,091•Hybrid

About The Position

A Brief Overview Investigate, analyze, and determine the extent of company's liability concerning Claims and attempt to effect settlement with claimants. Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Calculate benefit payments and approve payment of Claims within a certain monetary limit. All tasks are to be performed with the goal of demonstrating Zenith's superior Claims handling expertise. This role is eligible to participate in Zenith’s hybrid work schedule which provides the flexibility to work from home on select days of the week according to the in-office schedule established by regional executive leadership. Selected candidate must be able to report into the East Norriton, PA office on a weekly basis . Expierance with Pennsylvania (PA) and/or New Jersey (NJ) jurisdictions required. What you will do Under technical direction, works within significant limits and authority on assignments of higher technical complexity and coordination. Responsible for Claims management of assigned cases within guidelines of published performance standards. Opens new Claims, completes three-point contact, and performs needed investigations to determine compensability as well as possible subrogation or apportionment, according to state and/or Zenith’s timeframes and guidelines. Sets appropriate reserves according to Zenith’s timeframes and guidelines. Follows appropriate procedures for system documentation to preserve data integrity. Monitors and maintains accuracy of reserves over the life of the claim; when new information is received re-evaluates and recommends reserves according to Zenith’s standards. Creates and executes action plans needed to bring case to closure. Completes detailed settlement evaluations and recommends appropriate settlement value, within authority; negotiates claim settlements with injured workers and/or injured workers’ attorneys. Maintains regular contact with injured workers, employers and agents to develop positive relationships and establish credibility. Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions. Works productively and harmoniously with others on a consistence basis. Respond positively to direction and criticism of performance. Consistently maintain professional and appropriate demeanor. Perform other duties as assigned.

Requirements

High School Diploma Or equivalent required
1-7 years claim or insurance experience preferred.
Previous workers’ compensation experience required.
Basic technical workers’ compensation Claims knowledge.
Strong verbal and written communication skills with emphasis on telephone communication required.
Strong math and reading skills required.
Meets all state regulatory standards regarding licensing, continuing education, and other requirements.
Expierance with Pennsylvania (PA) and/or New Jersey (NJ) jurisdictions required.

Nice To Haves

Bachelor’s Degree or equivalent combination of training/experience preferred

Responsibilities

Investigate, analyze, and determine the extent of company's liability concerning Claims and attempt to effect settlement with claimants.
Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information.
Calculate benefit payments and approve payment of Claims within a certain monetary limit.
Works within significant limits and authority on assignments of higher technical complexity and coordination.
Responsible for Claims management of assigned cases within guidelines of published performance standards.
Opens new Claims, completes three-point contact, and performs needed investigations to determine compensability as well as possible subrogation or apportionment, according to state and/or Zenith’s timeframes and guidelines.
Sets appropriate reserves according to Zenith’s timeframes and guidelines.
Follows appropriate procedures for system documentation to preserve data integrity.
Monitors and maintains accuracy of reserves over the life of the claim; when new information is received re-evaluates and recommends reserves according to Zenith’s standards.
Creates and executes action plans needed to bring case to closure.
Completes detailed settlement evaluations and recommends appropriate settlement value, within authority; negotiates claim settlements with injured workers and/or injured workers’ attorneys.
Maintains regular contact with injured workers, employers and agents to develop positive relationships and establish credibility.
Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
Works productively and harmoniously with others on a consistence basis.
Respond positively to direction and criticism of performance.
Consistently maintain professional and appropriate demeanor.
Perform other duties as assigned.