Selective Insurance Company of America

  • Workers' Compensation Claims Technical Specialist

    Location US-NC-Charlotte
    Experience (Years)
    7
    Category
    Claims
    Status
    Full-Time Regular
    FLSA Status
    Exempt/Salaried
    Job ID
    6001
    Travel %
    10-15%
    Relocation Cost
    0
    Auto Reimbursement
    No
  • Overview

    The purpose of this position is to provide an expert level of claims management to losses that present complex factors and high exposure potential.  Investigate,
    negotiate and conclude by settlement or denial complex and challenging claims.
    The individual in this position will also ensure claims are processed within company policies, procedures, and individual's prescribed authority with exceptional standards of performance.  The candidate should possess skills to effectively and efficiently manage loss exposures, manage complex medical and disability issues and achieve appropriate resolutions.  All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements. 
    May be expected to attend in person mediations, trials or settlement conferences

    Responsibilities

    • Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, insureds, witnesses and others having pertinent information.
    • Analyze information in order to evaluate assigned claims to determine the extent of loss, taking into consideration coverage, compensability, medical risk factors and subrogation.   Assign
    • medical or other experts to case and arrange for medical examinations when necessary.
    • Process incoming calls and correspondence from insureds, claimants and agents regarding questions or problems associated with claims. Interact with underwriters and agents on claim
    • resolution.
    • Evaluate, negotiate and settle both non-litigated and litigated claims within delegated authority.  Handle litigation files from start to finish.
    • Exhibit appropriate and ongoing reserve evaluation skills.  Continuously evaluate the exposure of each loss as it progresses and ensure reserves are accurate.
    • Receive and approve expenses incurred to investigate, process, and handle a claim.
    • Review loss payments for causality, relatedness, and medical necessity within jurisdictional requirements.
    • Explore Second Injury Fund, credits for prior conditions and subrogation potential on all claims.
    • Prepare for and participate in new loss claim strategy sessions, claims review and settlement conferences.
    • Close claim by issuing check or denial and securing appropriate releases.  

     

    Qualifications

    • Must be able to handle Workers' Compensation claims from start to finish.
    • College degree preferred.
    • Prefer 7-10 years claims experience.
    • Multi-State claims experience with requisite licensing

     

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

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