Job Description

Job Summary

This position is for an experienced Workers' Compensation (WC) Claims Representative to manage lost time claims. The role involves working remotely to handle claims from multiple jurisdictions, including North Carolina, South Carolina, and Tennessee. The successful candidate will be responsible for evaluating compensability, negotiating settlements, and overseeing the entire claims process while maintaining consistent communication with stakeholders.

Responsibilities

• Determine compensability and coverage issues for lost time workers' compensation claims.
• Effectively manage a caseload of lost time claims across multiple jurisdictions (NC, SC, TN).
• Negotiate and direct settlements with management review.
• Gather medical and factual evidence to assess compensability.
• Direct external investigations and handle litigation files within given authority.
• Maintain regular contact with claimants, attorneys, outside investigators, rehabilitation personnel, and medical providers.
• Collaborate with insureds, account liaisons, and other stakeholders to ensure claims are managed efficiently.

Qualifications/Requirements

• Minimum of three years of experience handling workers' compensation claims.
• Experience managing claims in North Carolina, South Carolina, and/or Tennessee.
• Bachelor's degree required.
• Carrier experience is preferred.
• Proven experience handling lost time or litigated claims.
• Familiarity with medical terminology.
• Strong organizational, problem-solving, negotiation, and conflict resolution skills.
• Excellent verbal and written communication skills.

Compensation Package

• Salary: $70K - $87K per year (based on experience).
• Competitive benefits package, paid time off, professional development opportunities, etc.
• Fully remote work schedule.

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

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