Senior Claims Representative - Workers' Compensation

These positions investigate, evaluate and dispose of assigned claims in a timely manner in order to achieve best practices type settlements within legal statutes, policy provisions and Company and/or client guidelines.

Candidates may reside in any of the approved hiring markets, provided they can report to our Harrisburg, PA, Pittsburgh, PA or Waukesha, WI office on a hybrid basis.

POSITION COMPETENCIES

• Business Acumen
• Negotiation
• Results Oriented
• Time & Priority Management
• Decision Making

ESSENTIAL DUTIES

• Independently manage a dedicated caseload of complex, lost-time/indemnity, and litigated Workers' Compensation files.
• Gather factual and medical evidence, interview stakeholders, evaluate coverage, and determine claim compensability.
• Establish and adjust accurate financial reserves based on real-time claim developments and exposure analysis within company guidelines.
• Coordinate with defense counsel, handle hearing/mediation representation, negotiate settlements, and manage Medicare Set-Asides (MSAs) or liens.
• Identify and refer files for subrogation, fraud investigation (SIU), and structured return-to-work or modified-duty programs.
• Serve as a primary liaison between injured workers, employers, policyholders, medical providers, and agents.
• Maintains statutory and regulatory compliance by accurately and timely completing required workers’ compensation forms, EDI transactions, and jurisdictional filings throughout the life of the claim.
• Initiates self-development and training, in order to improve upon, maintain or acquire skills prescribed as promoting professional and personal growth in claims handling
• Develops claims files from initial assignment to disposition.
• Prepares claim file documentation accurately and completely in order to justify all actions taken and to provide an effective audit trail.
• Achieves a best practices type settlement in the disposition of claims.
• Completes actions on a timely basis, such as verifying coverages, setting or adjusting reserves, making appropriate contacts.
• Collaborates with Team Leader, Manager and Home Office as necessary to develop case strategy, moving the investigation along and disposing of the claim, in order to keep management, claimants, insureds and other interested parties satisfied that effective efforts are being made toward claim settlement.
• Performs other duties as may be assigned by the Reporting managers listed above.

SPECIAL RELATIONSHIPS

• In Penn National Insurance, these positions report to the Team Leader; Claims Manager and Director of Workers’ Compensation and Managed Care
• Direct contact with branch underwriting and/or claims service office personnel;
• Direct contact with Home Office claims personnel;
• Direct contact with agents, insureds, claimants, medical and legal professionals.

QUALIFICATIONS

Education/Credentials

• Continuing education in insurance-related courses such as IIA Certificate in General Insurance, Senior Claims Law Associate, and Associate in Claims courses
• Bachelor’s Degree preferred or insurance related experience and/or coursework.
• Adjuster's license or be willing to obtain one as required

Experience

• Minimum of 5 years of experience in workers' compensation claims handling

Technical/Professional Knowledge

• Must have a good understanding of state statutes applicable to assigned claims, the Unfair Claims Settlement Act and insurance policy coverages and provisions
• Must have a good understanding of terminology applicable to workers’ compensation
• Good communication skills, both oral and written
• Good inter-personal skills
• Good negotiation skills
• Good customer service skills
• Good analysis and evaluation skills
• Good decision-making skills
• Must have a strong sense of urgency
• Good PC skills, with an emphasis on Microsoft Office Products
• Good planning and organization skills

• Must be able to work independently as well as a member of a team

  The compensation has been carefully determined by considering a variety of important factors, including skill sets, experience, training, and certifications. With these considerations in mind, the estimated hiring range is $75,000 - $103,000. Additionally, you may be able to participate in our annual incentive program, depending on eligibility under the plan.

JOB REQUIREMENTS (as required by ADA – Americans with Disabilities Act)

• This position is primarily a sedentary position that requires occasional standing and walking throughout the office environment.
• Must be able to see and effectively use a computer monitor.
• Must be able to operate a computer, keyboard and applicable printers and other general office equipment.
• Must be able to access and enter information accurately using automated systems.
• Must be able to hear and communicate via the telephone and/or monitoring devices to both internal and external clients.
• Must be able to present information to individuals and groups.
• Must be able to interpret and apply concepts that may or may not be based upon established guidelines.
• Must be able to maintain acceptable attendance and adhere to scheduled work hours.
• Must have a valid driver’s license and be able to operate a motor vehicle.