Claim Specialist - Workers' Compensation
Core
Adjust assigned workers' compensation claims within delegated limits, conduct investigations, handle subrogation, and negotiate settlements.
Role type
Senior IC claims adjuster (workers' compensation)
Builds
Claim settlements and recovery actions for insureds and claimants
Domain
Insurance (P&C) / Workers' Compensation
Deliverable
client delivery
Required skills
claim investigation, reserve setting, settlement negotiation, subrogation, litigation management, regulatory compliance, data reporting
Preferred skills
litigation experience, multi-state licensing
Technologies
claims management systems
Responsibilities
Analyze moderate to complex claims to determine investigation needs; conduct thorough investigations including survey arrangements; initiate reserve changes and recommend adjustments when authority is exceeded; negotiate timely and equitable claim payments and settlements; handle subrogation including identification of responsible parties and negotiation of recovery; direct and monitor defense counsel performance and review legal expense bills; maintain case diaries and file documentation; communicate with customers (insureds, claimants, brokers) throughout the claims process; complete data reports to state agencies; ensure compliance with Fair Claims Practices Acts and state/federal regulations.
