Sr. Workers Comp Claims Rep (Hybrid/Remote)

At Selective, we don't just insure uniquely, we employ uniqueness. 

Our Business  

Selective is a midsized U.S. domestic property and casualty insurance company with a history of strong, consistent financial performance for nearly 100 years. Selective's unique position as both a leading insurance group and an employer of choice is recognized in a wide variety of awards and honors, including listing in Forbes Best Midsize Employers in 2024 and certification as a Great Place to Work® in 2024 for the 5th consecutive year. 

Working at Selective 

At Selective, we don't just insure uniquely – we employ uniqueness. Employees are empowered and encouraged to Be Uniquely You by being their true, unique selves and contributing their diverse talents, experiences, and perspectives to our shared success. Together, we are a high-performing team working to serve our customers responsibly by helping to mitigate loss, keep them safe, and restore their lives and businesses after an insured loss occurs.  

Selective Insurance offers a total rewards package that includes a competitive base salary, incentive plan eligibility at all levels, and a wide array of benefits designed to help you and your family stay healthy, achieve your financial goals, and balance the demands of your work and personal life. These benefits include comprehensive health care plans, retirement savings plan with company match, discounted Employee Stock Purchase Program, tuition assistance and reimbursement programs, and paid time off plans. Additional details about our total rewards package will be provided during the recruiting process. 

Click to learn more about the Selective Claim Culture and why Selective is right for YOU!  https://youtu.be/zuF1YgAyQfo

Selective Insurance is seeking a Sr. Workers Comp Claims Rep for our Charlotte, NC office. We will also consider remote for the ideal candidate if they reside outside of NC and SC.  

This position will be responsible for Investigating lost-time claims to determine coverage and compensability based on jurisdictional guidelines. Obtain relevant information necessary for a thorough investigation, be able to freeze facts of claims and make timely decisions. Effective and consistent partnership with nurse management to return injured worker back to gainful employment when necessary. Manage litigation of cases in collaboration with Staff and Panel Counsel. Manage administration of benefits and claim resolution. Provide compelling customer service.  Responsibility includes effective and timely communication with employer, employee, and medical provider.

JOB RESPONSIBILITIES;

• Receives assigned lost-time claims for investigation to determine coverage and compensability on claims with a disability period greater than 10 weeks.
• Processes claims which include the following activities: Making contacts, setting reserves, establishing file in MCS, evaluating exposure and establishing initial and subsequent reserves on claims with an exposure greater than $25,000, and analyzing investigational data. Makes timely payments and follows through to resolution.
• Handles both non-litigated and litigated cases.
• Collaborates with nurses and vendors on medical and disability management. Collaborates with Staff Counsel or Panel Counsel on litigated cases.
• Documents claims files and maintains control of work through documentation or diary system.
• Handles disputed facts, benefits, compensability, coverage, medical causality and relatedness.
• File state forms timely in accordance with statutory guidelines.
• Prepare for and participate in claims review and settlement conferences.
• Ensures compliance with company, state and federal regulations.

JOB QUALIFICATIONS:

• College degree preferred.
• 3 - 5 years claims experience preferred.
• Experience in New Jersey Workers Compensation
• Knowledge of workers compensation statutes, coverage and case law.
• Excellent written and verbal communication skills.
• Working knowledge of medical treatment and terms as related to medical only workers compensation claims.
• Critical thinking skills to assess compensability of WC claim as it relates to the facts and law. 

The expected starting salary range for this role is $62,000 - $98,000.  The actual base salary is based on geographic location, and the range is representative of salaries for this role throughout Selective's footprint. Additional considerations include relevant education, qualifications, experi