WC Claims Representative - Charlotte, NC (Hybrid)

About the role

At Selective, we don't just insure uniquely, we employ uniqueness. Selective is a midsized U.S. domestic property and casualty insurance company with a history of strong, consistent financial performance for nearly 100 years. Selective's unique position as both a leading insurance group and an employer of choice is recognized in a wide variety of awards and honors, including listing in Forbes Best Midsize Employers in 2025 and certification as a Great Place to Work® in 2025 for the sixth consecutive year. Employees are empowered and encouraged to Be Uniquely You by being their true, unique selves and contributing their diverse talents, experiences, and perspectives to our shared success. Together, we are a high-performing team working to serve our customers responsibly by helping to mitigate loss, keep them safe, and restore their lives and businesses after an insured loss occurs.

Selective Insurance is seeking a Workers Comp Claim Rep who will be handling claims for the Heartland Region (IA, IN, IL, KS, MI, MN, MO, WI). Responsibility includes 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. Effective and consistent partnership with nurse management to return injured worker back to gainful employment when necessary. Manage administration of benefits and claim resolution. Provide compelling customer service. All job duties and responsibilities 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 short disability period of 8 weeks or less (could occasionally exceed 8 weeks).
• Processes claims which include the following activities: making contacts, setting reserves, establishing file in MCS, evaluating exposure, and establishing initial and subsequent reserves on less severe claims with a general exposure of less than $75,000, and analyzing investigational data.
• Makes timely payments and follows through to resolution.
• May occasionally handle claims that exceed $75,000.
• Documents claim files and maintains control of work through documentation or diary system.
• Handles non-litigated and litigated claims.
• Files state forms timely in accordance with statutory guidelines.
• Collaborates with nurses and vendors on medical and disability management.
• 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 claim as it relates to the facts and law.
• College degree preferred.
• 1-