Claims Specialist IV, Workers Comp
Location:
Columbus , Ohio
Posted:
October 18, 2017
Reference:
1121522803
This position is a senior level Workers Compensation Claims role. The claims associate in this role will be expected to handle the most complex Workers Compensation claims. Multi-jurisdiction and multi-claims system knowledge is required. Ideal candidate will possess:

+ Multiple years handling workers compensation claims

+ Demonstrated ability to handle complicated medical and legal issues

+ Strong ability to partner with field leadership to achieve best claims outcomes

JOB SUMMARY: Supports the oversight and management of assigned Workers' Compensation claims. Provides support and guidance regarding coverage, compensability and benefits to field operations. Promotes and provides "On Your Side" customer service. Coordinates efforts between home office and field operations. Provides support, advice and guidance to staff and field personnel. Review and prepare analysis regarding the most serious and complex nature of workers' compensation claims requiring investigation, compensability, evaluation, and resolution. Monitor field operations financial and technical performance trends, identifying opportunities to improve performance and drive customer service initiatives in conjunction with Field Operations. Manages projects and vendor relationships to achieve desired business objectives, including identification and development process mapping with regard to data quality/integrity.RELATIONSHIP: Reports to Commercial Casualty AVPDIRECT REPORTS: NoneJOB RESPONSIBILITIES:1. Monitors complex litigated and non-litigated claims and provides technical assistance and consultation to state/regional leadership and associates. Adheres to high standards of professional conduct while providing the delivery of superior claims service support;2. Participate in Quality Assurance reviews.3. Recommends various methods of dispute resolution and settlement in those cases where warranted.4. Provides reserve analysis to ensure timely and accurate case reserves in accordance with Best Claims Practices.5. Maintains current knowledge of all insurance lines, court decisions, current guidelines and policy changes and modifications. This may require attendance at various seminars and training sessions.6. Serves as the subject matter expert to staff and field operations.7. Creates and analyzes severe incident reports, reinsurance reports and other information to home office, claims management, and underwriting.8. Leads or serves on various project teams as assigned based on business need. Contributes to the overall strategic vision and provides a broad range of ideas regarding process design, implementation, support and operation initiatives. Advises business and systems partners on the issues and problems that they will face as process implementation activities unfold. May serve in an operational authority or approval role in the execution of the processes.9. Assist Underwriting and Products in the review and development of new or existing policy language. Partners with Underwriting and Product regarding claim trends, state market analysis, needed systems changes and enhancements and other compliance issues.10. Initiates, develops, and maintains collaborative relationships with vendors, partners, and suppliers to support customer or systems plans. Managers service evaluations regarding outside service vendors.11. Monitor field operations performance, identifying opportunities to improve performance, and work with field leadership and personnel to implement improvement programs.12. Provides reserve analysis to insure timely and accurate case reserves in accordance with Best Claims Practices (BCPs).13. Provides advice, counsel, and training to field operations. Develops and facilitates formal training sessions and the Workers' Compensation Schools.14. Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective Nationwide customers.15. Other duties as assigned.JOB REQUIREMENTS:Education: Undergraduate studies in business administration or related field preferred and/or relevant Workers Compensation experienceLicenses/Designations: State licensing where required. Successful completion of required/applicable claims certification training/classes.Experience: Eight years workers' compensation claims experience. Field management experience preferred.Knowledge: Requires proven knowledge of workers' compensation insurance operations, field and staff functions, industry trends, and project management. Proven superior knowledge of best claims practices used to resolve the most serious and complex bodily injury. Proven knowledge of insurance contracts, medical terminology and legal aspects of court procedures affecting legal exposures for workers' compensation. Ability to operate various claims systems and related software.Skills/Competencies: Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience. Demonstrated decision-making and analytical skills. Strong oral and written communication skills and the ability to communicate with field leadership, staff management and other departments. Ability to provide a multi-jurisdictional analysis of coverage, compensability and benefits.Provide oversight and analysis regarding the selection and direction of defense counsel in cases involving serious and complex compensability/injury issues from inception through resolution. Organizational skills to effectively establish work priorities in accordance with objectives and standards.Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.Staffing Exceptions to the above Minimum Job Requirements must be approved by: Business Unit Executive and Human Resources.JOB CONDITIONS:Working Conditions: Normal office environment. May require ability to sit and use telephone and personal computer for extended periods of time. Must be willing to work irregular hours and to travel with possible overnight requirements. Must be available to work catastrophes (CAT) requiring travel to CAT site with multiple on-site responsibilities and/or for extended periods of time. Extended and/or non-standard hours as required.Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.Job Evaluation Activity: Edited 5/2/11 JTG

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