Nationwide · 10 hours ago
Claims Specialist I, Workers Compensation
United States
Full-time
Remote
Entry Level
$49K/yr - $101K/yr
1+ years exp
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Responsibilities
Provides appropriate notices to policyholders and injured employees per the applicable state workers’ compensation statute and obtains appropriate forms and documentation to verify employee/employer relationships and average weekly wage. Completes and files appropriate first and/or second notice of injury as required by individual state workers compensation statute and electronic data interchange reporting regulations.
Employs appropriate claims management techniques and direct intervention (e.g., independent medical examinations, referral for rehabilitation, utilization review, etc.) to manage each claim. Maintains contact with policyholders and injured worker and pursues return to work initiatives. Utilizes effective Telephonic Nurse Case Manager or Field Nurse Case Management services to assist with managing medical care and return to work activities. Consults with internal Claims Medical Specialist for future care needs and issues of life expectancy. Evaluates exposures, manages ongoing case reserves in alignment with Best Practices and negotiates settlements as appropriate. Documents significant activity and decision in each claim via on-line claim system.
Evaluates all pertinent information and works in conjunction with claimant/client to pursue most appropriate claims resolution. Promptly and effectively handles all assigned claims with moderate direction and oversight. Makes decisions within delegated authority as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service.
Manages litigated claim issues according to best claims practices. Obtains appropriate litigation budgets and develops appropriate power of attorney in partnership with counsel and manages litigation expenses of Nationwide Trial Division or approved outside counsel. Assists or prepares files for lawsuit, trial, or subrogation. (Property/Material Damage/Casualty).
Fully Investigates and pursues third-party recoveries and any applicable deductibles. May utilize the services of Nationwide recovery unit, and/or partner with designated outside counsel/trial division, or by giving notice of lien to plaintiff counsel handling third party litigation. Claim Zone Field assist referrals and/or outside consulting expert may be utilized to gather, obtain and secure critical information.
Partners with Special Investigative Unit and Subrogation to identify fraud and subrogation opportunities.
Maintains and develops current knowledge of: assigned insurance lines; court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars or training sessions.
Completes state and other regulatory reports/forms to include EDI forms as required by each State Workers’ Compensation Statute or State Regulatory Rules.
Reviews files for Medicare reporting obligations and submits appropriate Medicare query, Ongoing responsibility for Medicals (ORM) and Total Payment Obligation to claimant (TPOC) reports. May handle claims involving MSA's at time of settlement.
Delivers a positive customer service experience to all internal, external, current and prospective Nationwide customers. Initiates and conducts follow-ups via proficient use of claims systems and related business systems.
May periodically conduct customer/account visits to review reserves and discuss status of significant claims. May also present educational workshops to client personnel.
Qualification
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Required
Demonstrated customer service expertise.
Strong written & verbal communication skills.
One to three years of experience in workers’ compensation claims.
General knowledge of insurance theory and practices, insurance contracts and their application.
Familiarity with claims processing and claims best practices and procedures.
Proven knowledge of insurance contracts, medical terminology, workers compensation and the legal aspects of court procedures affecting legal liability for all lines of insurance.
Knowledge of claims systems.
Ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience.
Analytical skills necessary to make decisions/resolve conflicts such as application of coverage's to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions and direct repair shop claims management.
Ability to work in a fast paced, collaborative environment.
Possesses organizational skills to effectively prioritize and manage increased workloads.
Demonstrated communication skills for contact and/or negotiations with policyholders, claimants, repair persons, attorneys, agents and the public in general.
Ability to efficiently operate personal computer and software for claims-related and other business applications.
Preferred
Prior casualty claims handling experience is preferred.
1-3 years of works compensation, or work loss claims experience is a plus.
All lines adjusters (Texas or Florida) license preferred.
Undergraduate degree or equivalent experience preferred.
Familiarity with claims processing and claims best practices and procedures preferred.
Benefits
Medical/dental/vision
Life insurance
Short and long term disability coverage
Paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date
Nine paid holidays
8 hours of Lifetime paid time off
8 hours of Unity Day paid time off
401(k) with company match
Company-paid pension plan
Business casual attire
Company
Nationwide
Nationwide, a Fortune 100 company based in Columbus, Ohio, is one of the largest and strongest diversified insurance and financial services organizations in the United States.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Jim Fowler
Chief Technology Officer
Ramon Jones
Executive Vice President and Chief Marketing Officer
Recent News
2024-11-08
Google Patent
2024-11-08
Company data provided by crunchbase
