Workers Compensation Case Management Senior I

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Career Level: P3

Primary Purpose:
Manages the end-to-end handling of standard workers' compensation claims, applying judgment to resolve issues and maintain compliance. Drives timely resolution and cost control through proactive communication and accurate case evaluation.
Duties and Responsibilities:

• Administers various aspects of the claim file handling of both in-house and third-party administered claims through diligent investigation and assessment.
• Evaluates completed investigation and case facts to determine merits of each claim.
• Performs pre and post binding claim audits as needed and communicate the audit results to appropriate internal and external stakeholders.
• Assesses damages by calculating applicable damages or the range permitted by law; anticipates and understands settlement impacts and proactively addresses issues.
• Negotiates claim settlements using a negotiation strategy established by management as well as using available tools and resources within authority limits.
• Sets and reviews reserves promptly throughout the claims cycle within authority limits, including estimating and validating claim values.
• Reviews and assists subject matter experts with development of testimony, work papers and discovery responses, settlement documents and communications materials.
• Ensures an efficient records maintenance system for workers' compensation claims and related information, data, and activities.
• Performs other duties as assigned.

Required Qualifications:

• Typically requires a 4-year degree in a relevant field, or equivalent combination of relevant education and experience.
• Typically requires 5 years of related experience.

Required Knowledge, Skills and Abilities:

• Ability to coordinate effectively with medical providers and employers.
• Ability to influence outcomes through effective case planning.
• Ability to resolve non-routine claim issues using professional judgment.
• Knowledge of integrated workers' compensation case management frameworks.
• Knowledge of regulatory requirements and claim adjudication principles.
• Skill in evaluating medical, vocational, and functional information.
• Skill in managing moderate-complexity claims independently.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability or protected veteran status.