Claims Specialist

• Independently manage a caseload of moderate to highly complex workers’ compensation claims from investigation through resolution and closure
• Investigate claims and make timely compensability decisions
• Manage complex litigated, high-exposure, and catastrophic claims
• Coordinate with defense counsel and other specialized resources
• Manage medical treatment, disability, return-to-work, and indemnity benefits
• Establish and maintain accurate reserves based on current and anticipated claim exposure
• Develop and execute action plans to move claims toward appropriate resolution
• Evaluate settlement opportunities and negotiate within assigned authority
• Maintain timely communication with injured workers, employers, clients, attorneys, and medical providers
• Ensure compliance with state requirements, client instructions, and company best practices
• Identify and promptly escalate significant developments and changes in exposure
• Provide technical guidance and support to less-experienced adjusters as needed

Senior Workers Compensation Claims Adjuster

• Manage indemnity and medical workers’ compensation claims from investigation through cost-effective conclusion
• Evaluate claims and establish action plans for medical and indemnity benefits
• Determine compensability, benefit eligibility, claim outcomes, reserves and settlement strategies
• Gather facts through interviews and recorded statements
• Identify and pursue subrogation recoveries
• Consult with claim directors, return-to-work specialists, nurse case managers, medical professionals and legal counsel
• Collaborate with injured workers, employers, counsel and healthcare professionals to manage costs and promote quality care
• Facilitate injured workers’ safe and timely return to work
• Manage claims litigation, expenses and panel counsel
• Analyze reports from physicians, attorneys and vocational rehabilitation experts
• Evaluate and negotiate claim settlements
• Present claim details at internal team staffing and provide guidance
• Participate in claim reviews, onboardings and policyholder/agent meetings
• Develop presentations for special projects, meetings and conferences
• Collaborate with policyholders to align objectives and foster continuous improvement

Claims Specialist jobs in Connecticut

Senior Workers Compensation Claims Adjuster

Lost Time Claims Specialist – Workers' Compensation