The Jonus Group
Overview
Complex Claims Specialist - Workers' Compensation (WC) remote role with occasional travel for mediations, training, and departmental meetings. This position requires a strong background in handling complex and high-severity WC claims across multiple jurisdictions and offers the opportunity to contribute to a leading insurance organization. Job Summary
Seeking a highly skilled and experienced
Complex Claims Specialist
to join a Workers' Compensation team. This is a full-time, 100% remote position with occasional travel required for mediations, training, and departmental meetings. The ideal candidate will have a strong background in handling complex and high-severity Workers' Compensation claims across multiple jurisdictions. Compensation Package
Salary Range: $100,000 - $125,000 per year Competitive benefits package, 401(k), paid time off, professional development opportunities, etc. Responsibilities
Investigate coverage, determine compensability, and manage a caseload of high-exposure Workers' Compensation claims involving catastrophic injuries and complex cases. Establish and update reserves to reflect claim exposure and document supporting rationale. Resolve claims within authority and make case value recommendations to senior leadership for cases exceeding authority. Collaborate with outside defense counsel to manage litigated files effectively. Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills. Ensure compliance with state and federal Workers' Compensation regulations. Provide exceptional customer service to policyholders, agents, injured workers, medical providers, legal teams, and vendors. Develop creative resolution strategies for complex issues and utilize internal and external resources effectively. Document claim files in accordance with company and regulatory guidelines. Identify subrogation potential and red flags requiring SIU involvement. Train new team members and act as a technical resource for less experienced claims representatives. Maintain continuing education requirements. Qualifications/Requirements
Active adjuster license required. Minimum of 10 years of experience handling complex Workers' Compensation claims. Multi-state experience in jurisdictions such as New York, New Jersey, Maine, New Hampshire, Vermont, Massachusetts, Pennsylvania, Rhode Island, Connecticut, Delaware, Maryland, Washington DC, West Virginia, Virginia, North Carolina, and South Carolina (or willingness to learn additional jurisdictions). Proficiency in structured settlements and Medicare Set-Asides. Strong analytical, organizational, and time management skills. Excellent written and verbal communication skills. Ability to work independently in a virtual office environment and meet deadlines. Strong negotiation skills and the ability to prioritize tasks effectively. Proficiency in MS Word, Excel, and internet applications. Highly detail-oriented with the ability to execute sound judgment in sensitive situations. Education
Bachelor’s degree required. Industry designations such as AIC, SCLA, or CPCU are a plus. 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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Complex Claims Specialist - Workers' Compensation (WC) remote role with occasional travel for mediations, training, and departmental meetings. This position requires a strong background in handling complex and high-severity WC claims across multiple jurisdictions and offers the opportunity to contribute to a leading insurance organization. Job Summary
Seeking a highly skilled and experienced
Complex Claims Specialist
to join a Workers' Compensation team. This is a full-time, 100% remote position with occasional travel required for mediations, training, and departmental meetings. The ideal candidate will have a strong background in handling complex and high-severity Workers' Compensation claims across multiple jurisdictions. Compensation Package
Salary Range: $100,000 - $125,000 per year Competitive benefits package, 401(k), paid time off, professional development opportunities, etc. Responsibilities
Investigate coverage, determine compensability, and manage a caseload of high-exposure Workers' Compensation claims involving catastrophic injuries and complex cases. Establish and update reserves to reflect claim exposure and document supporting rationale. Resolve claims within authority and make case value recommendations to senior leadership for cases exceeding authority. Collaborate with outside defense counsel to manage litigated files effectively. Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills. Ensure compliance with state and federal Workers' Compensation regulations. Provide exceptional customer service to policyholders, agents, injured workers, medical providers, legal teams, and vendors. Develop creative resolution strategies for complex issues and utilize internal and external resources effectively. Document claim files in accordance with company and regulatory guidelines. Identify subrogation potential and red flags requiring SIU involvement. Train new team members and act as a technical resource for less experienced claims representatives. Maintain continuing education requirements. Qualifications/Requirements
Active adjuster license required. Minimum of 10 years of experience handling complex Workers' Compensation claims. Multi-state experience in jurisdictions such as New York, New Jersey, Maine, New Hampshire, Vermont, Massachusetts, Pennsylvania, Rhode Island, Connecticut, Delaware, Maryland, Washington DC, West Virginia, Virginia, North Carolina, and South Carolina (or willingness to learn additional jurisdictions). Proficiency in structured settlements and Medicare Set-Asides. Strong analytical, organizational, and time management skills. Excellent written and verbal communication skills. Ability to work independently in a virtual office environment and meet deadlines. Strong negotiation skills and the ability to prioritize tasks effectively. Proficiency in MS Word, Excel, and internet applications. Highly detail-oriented with the ability to execute sound judgment in sensitive situations. Education
Bachelor’s degree required. Industry designations such as AIC, SCLA, or CPCU are a plus. 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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