Sr WC Claims Rep
Selective Insurance is seeking a Sr. WC Claims Rep for our Charlotte, NC office.
This position will be responsible for Investigating lost-time claims to determine coverage and compensability based on jurisdictional guidelines. Obtain relevant information necessary for a thorough investigation, be able to 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 litigation of cases in collaboration with Staff and Panel Counsel. Manage administration of benefits and claim resolution. Provide compelling customer service. Responsibility includes effective and timely communication with employer, employee, and medical provider.
- Receives assigned lost-time claims for investigation to determine coverage and compensability on claims with a disability period greater than 10 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 claims with an exposure greater than $25,000, and analyzing 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.
- File state forms timely in accordance with statutory guidelines.
- Prepare for and participate in claims review and settlement conferences.
- Ensures compliance with company, state and federal regulations.
- College degree preferred.
- 3 - 5 years claims experience preferred.
- 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.
Selective is an Equal Employment Opportunity employer. Selective maintains a drug-free workplace.
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