The Jonus Group
Overview
Complex Claims Specialist - Workers' Compensation (Remote) at The Jonus Group. 100% remote position with occasional travel for mediations, training, and departmental meetings. Job Description
Complex Claims Specialist with a strong background in handling complex Workers’ Compensation claims, including catastrophic injuries. Responsible for managing a caseload of high-severity claims across multiple jurisdictions and ensuring compliance with Workers’ Compensation regulations. Compensation and Benefits
Salary Range: $100,000 - $125,000 (depending on experience) Competitive benefits package, 401(k), paid time off, professional development opportunities, etc. Responsibilities
Investigate coverage, determine compensability, and manage high-exposure Workers’ Compensation claims involving catastrophic injuries and complex cases. Establish and update reserves throughout the claim lifecycle with documented rationale. Resolve claims within authority limits and make case value recommendations to senior leadership for cases exceeding authority. Collaborate with outside defense counsel to manage litigated files in accordance with established guidelines. Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and 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 cases, utilizing internal and external resources effectively. Document claim files in accordance with company and regulatory guidelines. Identify subrogation potential and red flags requiring Special Investigations Unit (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 California, Arizona, Colorado, Wyoming, Texas, and Oklahoma (willingness to learn additional jurisdictions required). Proficiency in structured settlements and Medicare Set-Asides. Strong negotiation, analytical, organizational, and time management skills. Ability to work independently in a fast-paced, virtual office environment. Advanced verbal and written communication skills for interacting with internal and external stakeholders. Proficiency in MS Word, Excel, and internet applications. Highly detail-oriented with the ability to prioritize tasks effectively under pressure. Education
Bachelor’s degree required. Industry designations such as AIC, SCLA, or CPCU are a plus. Disclaimer: 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.
#J-18808-Ljbffr
Complex Claims Specialist - Workers' Compensation (Remote) at The Jonus Group. 100% remote position with occasional travel for mediations, training, and departmental meetings. Job Description
Complex Claims Specialist with a strong background in handling complex Workers’ Compensation claims, including catastrophic injuries. Responsible for managing a caseload of high-severity claims across multiple jurisdictions and ensuring compliance with Workers’ Compensation regulations. Compensation and Benefits
Salary Range: $100,000 - $125,000 (depending on experience) Competitive benefits package, 401(k), paid time off, professional development opportunities, etc. Responsibilities
Investigate coverage, determine compensability, and manage high-exposure Workers’ Compensation claims involving catastrophic injuries and complex cases. Establish and update reserves throughout the claim lifecycle with documented rationale. Resolve claims within authority limits and make case value recommendations to senior leadership for cases exceeding authority. Collaborate with outside defense counsel to manage litigated files in accordance with established guidelines. Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and 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 cases, utilizing internal and external resources effectively. Document claim files in accordance with company and regulatory guidelines. Identify subrogation potential and red flags requiring Special Investigations Unit (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 California, Arizona, Colorado, Wyoming, Texas, and Oklahoma (willingness to learn additional jurisdictions required). Proficiency in structured settlements and Medicare Set-Asides. Strong negotiation, analytical, organizational, and time management skills. Ability to work independently in a fast-paced, virtual office environment. Advanced verbal and written communication skills for interacting with internal and external stakeholders. Proficiency in MS Word, Excel, and internet applications. Highly detail-oriented with the ability to prioritize tasks effectively under pressure. Education
Bachelor’s degree required. Industry designations such as AIC, SCLA, or CPCU are a plus. Disclaimer: 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.
#J-18808-Ljbffr