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.
This position requires knowledge of NY, CT, MA, RI and NH Jurisdiction.
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.
1-3 years of claims experience preferred.
Selective is an Equal Employment Opportunity employer. Selective maintains a drug-free workplace.