Workers Compensation Claims Specialist - Northeast Region

Description

The Workers Compensation Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claim's management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers.

We are open to fill this position as an Associate Claims Specialist I (grade 10) or Claims Specialist I (grade 11) or Claims Specialist II (grade 12) depending on candidate experience.

We prefer candidates from Connecticut, Maine, New Hampshire, Rhode Island, Vermont, New Jersey, New York, Pennsylvania, Massachusetts. If you do live within 50 miles of Westborough, MA claims office, you will be required to go into the office twice per month.

Training is a critical component to your success and that success starts with reliable attendance. Attendance and active engagement during training is mandatory.

• Manages an inventory of claims to evaluate compensability/liability.
• Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
• Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.
• Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
• Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
• Performs other duties as assigned.

• BS/BA degree or equivalent work experience.
• Minimum of 1-2 years' experience in claims adjustment, general insurance or formal claims training.
• Required to obtain and maintain all applicable licenses.
• Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU).
• Knowledge of claims investigation techniques, medical terminology and legal aspects of claims preferred.
• Ability to travel for 1 week during training to our Plano, TX office

• California
• Los Angeles Incorporated
• Los Angeles Unincorporated
• Philadelphia
• San Francisco