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Nationwide · 12 hours ago

Claims Specialist II, Workers Compensation

Columbus, OH

Full-time

Hybrid

Mid Level

$70K/yr - $129K/yr

3+ years exp

Nationwide is a Fortune 100 company focused on helping people protect what matters most to them. They are seeking a Claims Specialist II to investigate and handle workers' compensation claims, ensuring fair resolutions and exemplary customer service.

BankingFinancial ServicesInsuranceLife Insurance

Responsibilities

Provides appropriate notices to policyholders and injured employees according to applicable state workers’ compensation statute and obtains appropriate forms and documentation to verify employee/employer relationship and average weekly wage. Completes and files appropriate first and 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 decisions 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

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

Manages litigated claim issues in alignment with Best Claims Practices. Obtains appropriate litigation budgets and develops appropriate power of attorney in partnership with counsel. Manages litigation expenses of Nationwide Trial Division or approved outside counsel

Manages assigned claims with little to no 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

Submits severe incident reports, reinsurance reports and other information to home office, claims management, and underwriting

Reviews files for Medicare reporting obligations and submits appropriate Medicare query, Ongoing responsibility for Medicals (ORM) and Total Payment Obligation to claimant (TPOC) reports. Responsible for claims involving Medicare Set Aside at time of settlement and which may be funded by a structured settlement

Partners with Special Investigative Unit (SIU) and Subrogation to identify fraud and subrogation opportunities

Delivers a positive customer service experience to all internal, external, current and prospective Nationwide customers

May periodically conduct customer/account visits to review reserves and discuss status of significant claims. May also present educational workshops to client personnel

Qualification

Workers Compensation ClaimsClaims Management TechniquesInsurance Contracts KnowledgeMedical TerminologyAnalytical SkillsNegotiation SkillsCustomer ServiceCommunication SkillsOrganizational SkillsLeadership Skills

Required

3-5 Years experience handling lost time and litigated claims in PA & IL

Three to five years prior experience in workers' compensation claims

Advanced knowledge of insurance theory and practices, insurance contracts and their application

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

Excellent customer focus and proven ability to proactively meet customer needs

Analytical skills necessary to make decisions and resolve conflict in such areas as application of coverage to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions

Ability to establish repair requirements and cost estimates for extensive losses and serves as a subject matter expert on respective claims projects

Proven organizational skills to effectively prioritize increased and more complex workloads

Demonstrates strong but flexible standards to balance the conflicting demands of the position

Excellent written and verbal communication skills necessary to effectively communicate and/or negotiate with policyholders, claimants, attorneys, agents, and general public

Demonstrated leadership capabilities to effectively train, coach, and provide feedback to less experienced associates

State licensing where required

Successful completion of required/applicable claims certification training/classes

Preferred

Undergraduate studies in business administration or related field preferred and/or relevant Workers' Compensation experience

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

And more

Company

Nationwide

Glassdoor3.9

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.

Founded in 1925

Columbus, Ohio, USA

10001+ employees