Sr WC Claims Rep - Charlotte, NC (Hybrid

Selective Insurance is seeking a Senior Workers’ Compensation Claim Representative for our Charlotte, NC office. This is a hybrid role with two days in office and three days remote.

About the role

Responsibilities include effective and timely communication with employer, employee, and medical provider. Investigate lost-time claims to determine coverage and compensability based on jurisdictional guidelines. Obtain relevant information necessary for a thorough investigation, freeze facts of claims, and make timely decisions. Partner with nurse management to return injured workers to gainful employment when necessary. Manage litigation of cases in collaboration with staff and panel counsel. Administer benefits and resolve claims while providing compelling customer service. All duties must be carried out in compliance with applicable legal and regulatory requirements.

Responsibilities

• Receives assigned lost-time claims for investigation to determine coverage and compensability on claims with a disability period greater than 10 weeks.
• Processes claims including making contacts, setting reserves, evaluating exposure, and establishing initial and subsequent reserves on claims with an exposure greater than $100,000; analyzes investigational data.
• Makes timely payments and follows through to resolution.
• Handles both non-litigated and litigated cases.
• Collaborates with nurses and vendors on medical and disability management.
• Collaborates with staff counsel or panel counsel on litigated cases.
• Documents claims files and maintains control of work through documentation or diary system.
• Handles disputed facts, benefits, compensability, coverage, medical causality, and relatedness.
• Files state forms timely in accordance with statutory guidelines.
• Prepares for and participates in claims review and settlement conferences.
• Ensures compliance with company, state, and federal regulations.

Qualifications

• Knowledge of workers’ compensation statutes, coverage, and case law.
• Excellent written and verbal communication skills.
• Working knowledge of medical treatment and terms as related to medical-only workers’ compensation claims.
• Critical thinking skills to assess compensability of WC claims as it relates to the facts and law.
• College degree preferred.
• 3–5 years claims experience preferred.

Pay

USD $69,000.00 – USD $89,000.00 per year. Actual base salary is based on geographic location; additional considerations include relevant education, qualifications, experience, skills, performance, and business needs.