Claims Specialist II, Workers Compensation

Location: Remote within any of the lower 48 U.S. states

Salary: $69,500–$129,000 national range; expected starting range of $69,500–$103,500 annually

Company

hirify.global is a Fortune 100 insurance company providing property and casualty coverage and customer-focused claims services.

What you will do

• Investigate and manage medical and loss-of-time workers’ compensation claims across multiple states.
• Determine compensability, benefits, average weekly wage, benefit rates, exposures, and case reserves under applicable statutes.
• Coordinate medical care, return-to-work initiatives, independent medical examinations, rehabilitation referrals, utilization reviews, and nurse case management.
• Manage litigated claims, litigation budgets, counsel relationships, settlements, Medicare reporting, and Medicare Set-Aside requirements.
• Investigate third-party recovery, deductibles, fraud, and subrogation opportunities with internal units and outside counsel.
• Communicate with policyholders, injured workers, medical providers, attorneys, agents, and clients; conduct account visits and educational workshops when required.

Requirements

• Three to five years of workers’ compensation claims experience.
• Advanced knowledge of insurance theory, contracts, claims practices, workers’ compensation, medical terminology, and relevant legal procedures.
• State licensing where required and successful completion of applicable claims certification training.
• Strong investigation, analytical, organizational, written, verbal communication, negotiation, and conflict-resolution skills.
• Ability to manage assigned claims with little to no oversight and make decisions within delegated authority.
• Must be eligible to work remotely within the lower 48 U.S. states; travel to customer accounts and catastrophe sites may be required.

Culture & Benefits

• Full-time exempt position in a normal office environment with extended computer and telephone use.
• Medical, dental, and vision insurance, life insurance, and short- and long-term disability coverage.
• Paid time off, nine paid holidays, Lifetime paid time off, and Unity Day paid time off.
• 401(k) with company match and a company-paid pension plan.
• Work may include irregular, extended, or non-standard hours and overnight travel for catastrophe assignments.
• Credit and/or background checks are required as part of the selection process.