Claims Specialist II, 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 and handle medical and/or loss-of-time workers compensation claims from multiple states to determine compensability, entitled benefits, average weekly wage and benefit rate according to applicable state workers’ compensation statute. We’ll count on you to promote and provide exemplary customer service. Key to success will be your ability to establish timely and appropriate case reserves aligned with Best Practices and manage claims to appropriate resolution. You’ll also communicate frequently with customers, injured workers and medical providers.

• Provides appropriate notices to policyholders and injured employees according to applicable state workers’ compensation statute and obtains appropriate forms and documentation to verify employee/employer relationship and average weekly wage. Completes and files appropriate first and 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 decisions 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.
• 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.
• Manages litigated claim issues in alignment with Best Claims Practices. Obtains appropriate litigation budgets and develops appropriate power of attorney in partnership with counsel. Manages litigation expenses of Nationwide Trial Division or approved outside counsel.
• Manages assigned claims with little to no 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.
• Submits severe incident reports, reinsurance reports and other information to home office, claims management, and underwriting.
• Reviews files for Medicare reporting obligations and submits appropriate Medicare query, Ongoing responsibility for Medicals (ORM) and Total Payment Obligation to claimant (TPOC) reports. Responsible for claims involving Medicare Set Aside at time of settlement and which may be funded by a structured settlement.
• Partners with Special Investigative Unit (SIU) and Subrogation to identify fraud and subrogation opportunities.
• Delivers a positive customer service experience to all internal, external, current and prospective Nationwide customers.
• May periodically conduct customer/account visits to review reserves and discuss status of significant claims. May also present educational workshops to client personnel.

#claims Smoke-Free Iowa Statement: Nationwide Mutual Insurance Company, its affiliates and subsidiaries comply with the Iowa Smokefree Air Act. Smoking is prohibited in all enclosed areas on or around company premises as well as company issued vehicles. The company offers designated smoking areas in which smoking is permitted at each individual location. The Act prohibits retaliation for reporting complaints or violations. For more information on the Iowa Smokefree Air Act, individuals may contact the Smokefree Air Act Helpline at 888-944-2247.
For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) 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 II, Workers Compensation : $58,000.00-$120,000.00 The expected starting salary range for Claims Specialist II, Workers Compensation : $64,500.00 - $96,500.00