Claims Specialist I, Workers' Compensation

If you’re passionate about helping people protect what matters most to them, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! Do you have a strong desire to provide prompt, courteous and fair service to customers? Are you a skilled investigator, negotiator and communicator? If you thrive in an environment where you can problem-solve workers’ compensation claims resolution, while following processes that provide fair resolution, customer satisfaction and cost management, then we want to hear from you!

As a Claims Specialist, you’ll investigate medical and/or loss-of-time workers’ compensation claims with limited exposures from multiple states to determine compensability, entitled benefits, and average weekly wage and benefit rate according to the applicable state workers’ compensation statute. We’ll count on you to promote and provide exemplary customer service. Keys to success will be your ability to establish timely and appropriate case reserves in keeping with best practices and managing claims to appropriate resolution. You’ll also communicate frequently with customers, injured workers and medical providers.

• Provides appropriate notices to policyholders and injured employees per the applicable state workers’ compensation statute and obtains appropriate forms and documentation to verify employee/employer relationships and average weekly wage. Completes and files appropriate first and/or second notice of injury as required by individual state workers compensation statute and electronic data interchange reporting regulations.
• Employs appropriate claims management techniques and direct intervention (e.g., independent medical examinations, referral for rehabilitation, utilization review, etc.) to manage each claim. Maintains contact with policyholders and injured worker and pursues return to work initiatives. Utilizes effective Telephonic Nurse Case Manager or Field Nurse Case Management services to assist with managing medical care and return to work activities. Consults with internal Claims Medical Specialist for future care needs and issues of life expectancy. Evaluates exposures, manages ongoing case reserves in alignment with Best Practices and negotiates settlements as appropriate. Documents significant activity and decision in each claim via on-line claim system.
• Evaluates all pertinent information and works in conjunction with claimant/client to pursue most appropriate claims resolution. Promptly and effectively handles all assigned claims with moderate direction and oversight. Makes decisions within delegated authority as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service.
• Manages litigated claim issues according to best claims practices. Obtains appropriate litigation budgets and develops appropriate power of attorney in partnership with counsel and manages litigation expenses of Nationwide Trial Division or approved outside counsel. Assists or prepares files for lawsuit, trial, or subrogation. (Property/Material Damage/Casualty).
• Fully Investigates and pursues third-party recoveries and any applicable deductibles. May utilize the services of Nationwide recovery unit, and/or partner with designated outside counsel/trial division, or by giving notice of lien to plaintiff counsel handling third party litigation. Claim Zone Field assist referrals and/or outside consulting expert may be utilized to gather, obtain and secure critical information.
• Partners with Special Investigative Unit and Subrogation to identify fraud and subrogation opportunities.
• Maintains and develops current knowledge of: assigned insurance lines; court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars or training sessions.
• Completes state and other regulatory reports/forms to include EDI forms as required by each State Workers’ Compensation Statute or State Regulatory Rules.
• Reviews files for Medicare reporting obligations and submits appropriate Medicare query, Ongoing responsibility for Medicals (ORM) and Total Payment Obligation to claimant (TPOC) reports. May handle claims involving MSA's at time of settlement.
• Delivers a positive customer service experience to all internal, external, current and prospective Nationwide customers. Initiates and conducts follow-ups via proficient use of claims systems and related business systems.
• May periodically conduct customer/account visits to review reserves and discuss status of significant claims. May also present educational workshops to client personnel.

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Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. The national salary range for Claims Specialist I, Workers Compensation : $46,400.00-$96,200.00 The expected starting salary range for Claims Specialist I, Workers Compensation : $51,600.00 - $77,600.00