Claims Specialist - Workers Compensation

Employment Type: Full time

Location Type: Flexible (Virtual and/or Remote)

Position Overview

Nationwide's Property and Casualty team is seeking passionate individuals to help people protect what matters most and innovate processes to provide exceptional customer value. If you are driven by delivering extraordinary care and have a strong desire to provide prompt, courteous, and fair service, this role is for you.

What to Expect

This role involves managing a variety of workers' compensation claims with varying degrees of complexity across all Nationwide channels, including Agribusiness, Standard Commercial, and E&S. You will support complicated states, particularly New York and the Northeast Region. You will investigate and handle medical and/or loss-of-time workers' compensation claims from multiple states to determine compensability, benefits, average weekly wage, and benefit rates according to applicable state statutes. Key responsibilities include promoting exemplary customer service, establishing timely and appropriate case reserves, managing claims to resolution, and frequent communication with customers, injured workers, and medical providers.

Key Responsibilities

• Investigate and handle workers' compensation claims of varying complexity.
• Determine compensability, entitled benefits, average weekly wage, and benefit rate according to applicable state workers’ compensation statutes.
• Provide prompt, courteous, and fair service to customers.
• Promote and provide exemplary customer service.
• Establish timely and appropriate case reserves aligned with Best Practices.
• Manage claims to appropriate resolution.
• Communicate frequently with customers, injured workers, and medical providers.
• Provide appropriate notices to policyholders and injured employees according to applicable state workers’ compensation statute.
• Obtain appropriate forms and documentation to verify employee/employer relationship and average weekly wage.
• Complete and file appropriate first and second notice of injury as required by individual state workers’ compensation statute and electronic data interchange reporting regulations.
• Employ appropriate claims management techniques and direct intervention (e.g., independent medical examinations, referral for rehabilitation, utilization review).
• Maintain contact with policyholders and injured worker and pursue return to work initiatives.
• Utilize Telephonic Nurse Case Manager or Field Nurse Case Management services to assist with managing medical care and return to work activities.
• Consult with internal Claims Medical Specialist for future care needs and issues of life expectancy.
• Evaluate exposures and manage ongoing case reserves in alignment with best practices.
• Negotiate settlements as appropriate.
• Document significant activity and decisions in each claim via on-line claim system.
• Evaluate all pertinent information and work in conjunction with claimant/client to pursue the most appropriate claims resolution.
• Investigate and pursue third-party recoveries and any applicable deductibles.
• May utilize Nationwide recovery unit services, partner with designated outside counsel/trial division, or give notice of lien to plaintiff counsel handling third-party litigation.
• May utilize Claim Zone Field assist referrals and/or outside consulting experts.

Ideal Candidate Qualifications

• 1-3 years of Workers Compensation or loss time claims experience is highly preferred.
• New York Workers Compensation experience is a plus.
• Prior litigation and insurance experience is preferred.
• Skilled investigator, negotiator, and communicator.
• Ability to problem-solve workers’ compensation claims resolution.
• Proficiency in following processes for fair resolution, customer satisfaction, and cost management.

Company Information

At Nationwide®, "on your side" goes beyond just words. Our customers are at the center of everything we do, and we're looking for associates who are passionate about delivering extraordinary care.