WC Complex Med Only Adjuster -Charlotte, NC (Hybrid)

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.

About the role

This is a hybrid role based in our Charlotte office, with 2 days in the office and 3 days remote. Experience handling claims in IA, IL, IN, KS, MI, MO, or WI is preferred. The role involves effective and timely communication with employers, employees, and medical providers, investigating medical-only claims to determine coverage, compensability, and subrogation potential based on jurisdictional guidelines.

Responsibilities

• Receive and investigate complex medical-only claims through telephone or written communication with insureds, claimants, and providers to determine coverage, compensability, subrogation potential, and appropriate course of action.
• Handle mostly non-indemnity claims (no lost time within waiting period), medical causality, denied claims (not compensable and not covered), and medical claim petitions. Occasionally manage claims with minimal permanency benefits (indemnity).
• Establish initial and subsequent reserves on complex medical-only claims with a general exposure of less than $30,000.
• Process claims, including making contacts, setting reserves, evaluating exposure, adjusting reserves, making timely payments, and resolving claims.
• Document claim files and maintain control of work through a documentation or diary system.
• Manage medical-only claims with some complexity that may require a nurse consult, diagnostics, and minor medical procedures. Understand medical terminology and injury mechanisms, and recognize comorbidities that may complicate injury and recovery.
• File state forms timely in accordance with statutory guidelines.
• Ensure compliance with company, state, and federal regulations, including accurate and timely data updates for electronic data interchange with state and Medicare.
• Handle disputed facts, benefits, compensability, coverage, medical causality, and relatedness.
• Receive assigned claims from the medical-only unit, notice of loss coordinator, or lost-time adjusters.

Requirements

• 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 they relate to the facts and law.

Qualifications

• College degree preferred.
• 1-3 years of claims experience preferred.

Benefits

• Competitive base salary and incentive plan eligibility.
• Comprehensive health care plans.
• Retirement savings plan with company match.
• Discounted Employee Stock Purchase Program.
• Tuition assistance and reimbursement programs.
• 20 days of paid time off.

Pay

Actual base salary is based on geographic location, with a range of $55,000–$68,000 per year, depending on relevant education, qualifications, experience, skills, performance, and business needs.

Schedule

Hybrid schedule: 2 days in the office (Charlotte) and 3 days remote.