Workers Compensation Claims Technical Specialist (East)
About The Position
The Workers Compensation Claims Technical Specialist partners with the Claims Director to manage high-exposure workers compensation claims in the East region, including catastrophic injuries, serious loss exposures, and other complex matters. The specialist serves as a technical resource to claims professionals, helping develop effective claim strategies, achieve strong claim outcomes, and support operational excellence. The position works with specialty resources such as medical and legal professionals and collaborates with claims units and claim handlers on complex cases. The role is ideally based in Wilkes-Barre, Pennsylvania, and follows a hybrid schedule of two remote days and three in-office days.
Requirements
- College degree or at least 5 years of workers compensation experience.
- Analytical thinking skills, including identifying problems or opportunities, analyzing and comparing information, recognizing cause-and-effect relationships, and exploring solutions that support sound decision-making.
- Clear and concise oral and written communication skills.
- Ability to effectively present file resolutions to internal and/or external stakeholders.
- Mastery of evaluation, negotiation, and case resolution skills.
- Ability to understand alternatives, influence stakeholders, and reach fair agreements through discussion and compromise.
- Advanced investigative skills, including the ability to take statements.
- Advanced ability to determine liability, assign dollar values based on claimed and estimated damages, and set and readjust reserves.
- Advanced ability to assess settlement approaches, determine when to make an offer, and determine what to include in a settlement offer package.
- Thorough knowledge and understanding of state, federal, and regulatory laws and statutes; rules of evidence; chain of custody; trial preparation and discovery; court proceedings; and other rules and regulations applicable to the insurance industry.
Responsibilities
- Collaborate with specialty resources, such as medical and legal professionals, to manage medical treatment and lost-time benefits in cases with extremely complex issues or potentially high financial exposure.
- Co-manage appropriate claims with the Claims Unit, which assists with disability and treatment projections, reserving, and investigative suggestions for complex or catastrophic losses.
- Develop strategies for losses involving complex statutory benefit entitlement, medical diagnoses, Medicare Set Aside, or injury severity to achieve the best possible resolution.
- Facilitate timely claim resolution by leveraging mitigation opportunities.
- Participate in reserving and strategy discussions with claim handlers and senior management.
- Identify staff skill gaps and collaborate on training recommendations to strengthen performance across service offices.
- Support administrative tasks, respond to inquiries, and assist with operational research as needed.
- Participate in telephonic and/or onsite file reviews.
Benefits
- Competitive pay
- Generous paid time off
- Medical insurance starting day one
- Dental insurance starting day one
- Vision insurance starting day one
- 401(k)
- Tuition reimbursement
- Longevity bonuses
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
