Workers Compensation Litigated Claims Specialist II

Zurich Insurance Group•Schaumburg, IN

20d•Hybrid

About The Position

Zurich North America Claims is seeking a sharp, solutions-driven Workers Compensation Litigated Claims Specialist II to join their high-performing team. This role offers an opportunity to make a meaningful impact at a company known for innovation and excellence in the insurance industry. The position involves managing litigated workers’ compensation claims in Indiana, Illinois, Michigan, South Dakota, Nebraska, and Ohio. The specialist will manage Worker’s Compensation multi-party commercial line claims of moderate to high exposure and complexity within specific authority limits, ensuring efficient and effective handling while delivering customer-centric claims service.

Requirements

Bachelor degree and 3 or more years of experience in the Claims or Insurance area OR Zurich Certified Insurance Apprentice, including an associate degree with 3 or more years of experience in the 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 Equivalent and 5 or more years of experience in the Claims or Insurance area.
Must obtain and maintain required adjuster license(s)
Microsoft Office experience
Knowledge of insurance regulations, markets and products

Nice To Haves

5 plus years of experience handling high-exposure Workers Compensation claims involving complex medical, legal, and indemnity issues.
Demonstrated ability to manage litigated claims , collaborate with defense counsel, and participate in mediations, settlement conferences, and alternative dispute resolution.
Experience handling claim transfers and transitions , with the ability to quickly assess exposure, establish action plans, and drive claims toward resolution.
Knowledge of Owner-Controlled Insurance Programs (OCIPs) and Wrap-Up programs , including construction-related claim handling and coverage considerations.
Strong understanding of coverage analysis, compensability determinations, and reserve management .
Experience identifying and pursuing risk transfer opportunities , including contractual liability and third-party recovery potential.
Professional experience working for an insurance carrier(s)
Experience handling commercial claims
Jurisdictions in the following states: IN, MI, SD, NE, OH and IL
Exceptional verbal and written communication skills, with the ability to clearly convey complex coverage determinations to clients, customers, and brokers.
Analytical thinker with strong problem-solving, critical thinking, and financial acumen; skilled in interpreting insurance policies, evaluating exposure, and identifying actuarial trends.
Adept at multi-tasking and prioritization in fast-paced environments, with a proactive approach to sharing insights and optimizing outcomes across functions.
Proven ability to collaborate across teams, build cross-functional relationships, and leverage diverse perspectives to improve claim outcomes.
Experienced in guiding complex litigated claims, including directing counsel, managing litigation strategy, and following best practices for reserving indemnity, medical, and expense components.

Responsibilities

Document claims file by accurately capturing and updating claims data/information in compliance with best practices for worker’s compensation claims of moderate to high exposure and complexity.
Exercise judgment to determine compensability 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.