Selective Insurance · 6 hours ago

Sr WC Claims Rep

United States

Full-time

Remote

Mid, Senior Level

$62K/yr - $98K/yr

3+ years exp

Maximize your interview chances

FinanceFinancial Services

Insider Connection @Selective Insurance

Discover valuable connections within the company who might provide insights and potential referrals.
Get 3x more responses when you reach out via email instead of LinkedIn.

Responsibilities

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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Workers Compensation knowledgeClaims investigationMedical terminologyCollege degree3-5 years claims experienceWorkers Compensation experience