Selective Insurance Company of America

Workers Compensation Claims Representative

US-NC-Charlotte
Experience (Years)
1
Category
Claims
Status
Full-Time Regular
FLSA Status
Exempt/Salaried
Job ID
5615
Travel %
0-5%

Overview

Responsibility includes effective and timely communication with employer, employee, and medical provider.
Effective and consistent partnership with nurse management to return injured worker back to gainful employment when necessary; administration of benefits, litigation management and claim resolution, and handling multiple jurisdictions.
All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.

Responsibilities

  • Receives assigned claims for medical and disability management.
  • Processes claims which include the following activities: set up file in ACS, establish initial reserves, analyze investigational data, settle claims, reserve claim for probable ultimate payout, explore subrogation potential, closes claims and secures appropriate releases. 
  • Documents claims files and maintain control of work through documentation or diary system. 
  • Assigns litigated claims to an attorney who manages defense claim.
  • File state forms timely in accordance with statutory guidelines
  • Assign nurse case management or other experts to case and arrange when necessary.
  • Prepare for and participate 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. 
  • 3 - 5 years claims experience preferred.
  • 1-2 years appraisal experience preferred.
  • 1 year data entry experience preferred.

 

Selective is an Equal Employment Opportunity employer. Selective maintains a drug-free workplace.

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