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Senior Workers' Compensation Claims Specialist
2 months ago
We are seeking a highly skilled Senior Workers' Compensation Claims Analyst to join our team at Coventry WCS. As a key member of our claims team, you will be responsible for investigating, evaluating, and resolving complex workers' compensation claims in a timely and efficient manner.
Key Responsibilities- Claim Investigation and Evaluation: Independently investigate and evaluate assigned litigated and lost time workers' compensation claims to determine compensability and establish claim reserves.
- Claim Resolution: Work with claimants, employers, and medical providers to resolve claims in a timely and cost-effective manner.
- Medical Management: Collaborate with medical providers to develop and implement treatment plans that promote optimal recovery and return-to-work outcomes.
- Return-to-Work Coordination: Work with employers to facilitate return-to-work arrangements, including modified duty assignments and vocational rehabilitation.
- Third-Party Recovery: Identify and pursue third-party recovery opportunities, including subrogation, second injury fund, and excess or reinsurance reimbursement.
- Disability and Pension Credits: Identify and apply disability or pension credits or offsets where applicable.
- Claim Reserve Management: Establish and maintain claim reserves, adjusting as necessary to reflect changes in claim exposure.
- Litigation Management: Evaluate and manage litigation, working with defense counsel to establish strong defenses and pursue optimal outcomes.
- Education: High School Diploma (or equivalent) or Associate's or Bachelor's degree preferred, or five or more years of equivalent work experience required in an insurance, medical/health, or legal-related industry.
- Experience: At least 5-6 years of experience handling workers' compensation claims required; more experience may be required depending on claim complexity.
- Training and Certifications: Completion of workers' compensation training courses internally and/or externally in all significant areas affecting workers' compensation claims handling and practices.
- Licenses and Certifications: Workers' compensation licenses, certifications, awards preferred.
We offer a comprehensive benefits package, including medical, dental, vision, health savings accounts/flexible spending accounts, life and AD&D insurance, 401(k), tuition reimbursement, and resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market.
