Sr WC Claims Rep - (Hybrid/Remote)

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

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 fifth consecutive year.

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 is seeking a Sr. Workers Comp Rep who has experience handling claims for the Mid-Atlantic region; specifically, PA, MD, DE, DC WV, and NJ. This role is hybrid but will consider remote for the right individual.

Responsibility includes effective and timely communication with employer, employee, and medical provider. Investigate 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. As a Senior WC claims representative, you will utilize your knowledge and expertise of workers compensation to thoroughly investigate, evaluate and resolve complex lost time claims. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.

• Receives assigned lost time claims for investigation to determine coverage and compensability on claims with a disability and complex medical and litigation exposures.
• Promptly reviews policy coverage, completes initial contacts, determines compensability, evaluates exposure, establishes initial and subsequent reserves on claims with exposure up to and sometimes greater than $100k, and analyzes investigational data. Makes timely payments and follows through to resolution. Handles both non-litigated and litigated cases.
• Handles both non-litigated and litigated cases. Collaborates and establishes strategic and thoughtful plans of action with Staff or Panel Counsel.
• Collaborates with nurses and vendors on medical and disability management.
• Documents claims files and maintains control of work through documentation or diary system. Demonstrates sound technical proficiency through consistent execution per best practices.
• Handles disputed facts, benefits, compensability, coverage, medical causality, relatedness, settlement evaluations and negotiations.
• 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.
• Fosters collaboration, partnership and communication to achieve organizational goals. Believes the team is more powerful than the individual.

Knowledge and Requirements

• 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.

Education and Experience

• College degree preferred.
• 5+ years claims experience preferred.
• Experience handling W/C claims in PA, MD, DE, DC WV and NJ.

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.

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, experience, skills, performance, and business needs.

Selective is an Equal Employment Opportunity employer. That means we respect and value every individual's unique opinions, beliefs, abilities, and perspectives. We are committed to promoting a welcoming culture that celebrates diverse talent, individual identity, different points of view and experiences - and empowers employees to contribute new ideas that support our continued and growing success. Building a highly engaged team is one of our core strategic imperatives, which we believe is enhanced by diversity, equity, and inclusion. We expect and encourage all employees and all of our business partners to embrace, practice, and monitor the attitudes, values, and goals of acceptance; address biases; and foster diversity of viewpoints and opinions.