[Hiring] Claims Specialist II, Workers Compensation @Nationwide

Role Description

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you!

As a Claims Specialist, you’ll investigate and handle medical and/or loss-of-time workers compensation claims from multiple states to determine compensability, entitled benefits, average weekly wage and benefit rate according to applicable state workers’ compensation statute. We’ll count on you to promote and provide exemplary customer service.

• Investigate and handle claims.
• Establish timely and appropriate case reserves aligned with Best Practices.
• Communicate frequently with customers, injured workers, and medical providers.

Key Responsibilities

• Provide appropriate notices to policyholders and injured employees according to applicable state workers’ compensation statute.
• Complete and file appropriate first and second notice of injury as required.
• Employ appropriate claims management techniques and direct intervention.
• Maintain contact with policyholders and injured workers.
• Utilize effective Telephonic Nurse Case Manager or Field Nurse Case Management services.
• Consult with internal Claims Medical Specialist for future care needs.
• Evaluate exposures and manage ongoing case reserves.
• Document significant activity and decisions in each claim via on-line claim system.
• Investigate and pursue third party recoveries and any applicable deductibles.
• Manage litigated claim issues in alignment with Best Claims Practices.
• Submit severe incident reports, reinsurance reports, and other information to home office.
• Review files for Medicare reporting obligations.
• Partner with Special Investigative Unit (SIU) and Subrogation to identify fraud and subrogation opportunities.
• Deliver a positive customer service experience to all internal and external customers.
• Conduct customer/account visits to review reserves and discuss status of significant claims.
• May perform other responsibilities as assigned.

Qualifications

• Undergraduate studies in business administration or related field preferred.
• State licensing where required.
• Successful completion of required/applicable claims certification training/classes.
• Three to five years prior experience in workers’ compensation claims.

Requirements

• Advanced knowledge of insurance theory and practices.
• Familiarity with claims processing and claims best practices.
• Proven knowledge of insurance contracts, medical terminology, and legal aspects of court procedures.
• Excellent customer focus and proven ability to proactively meet customer needs.
• Analytical skills necessary to make decisions and resolve conflict.
• Excellent written and verbal communication skills.
• Demonstrated leadership capabilities to effectively train and coach less experienced associates.

Benefits

• Medical/dental/vision coverage.
• Life insurance.
• Short and long term disability coverage.
• Paid time off with a minimum of 18 days each full calendar year.
• Nine paid holidays.
• 401(k) with company match.
• Company-paid pension plan.
• Business casual attire.