Job Title: Senior Workers Compensation Claims Specialist
Company Overview:
Pulivarthi Group is a premier global provider of staffing and IT technology solutions, renowned for delivering exceptional services tailored to each client's unique needs. With a steadfast commitment to excellence, we merge expertise with innovation, ensuring cost-effective solutions of the highest quality. Our diverse client base spans healthcare, finance, government, and beyond, reflecting our adaptability and proficiency across industries. Operating in the United States, Canada, and Mexico, we pride ourselves on aligning with clients' cultures, deploying top-tier talent, and utilizing cutting-edge technologies. Pulivarthi Group stands as a beacon of reliability, efficiency, and innovation in the realm of staffing solutions.
Job Overview/Summary:
We are seeking an experienced Senior Workers Compensation Claims Specialist to join our team. In this role, you will manage moderate to high exposure workers compensation claims, ensuring compliance with best practices and company standards. You will use your analytical and decision-making skills to drive timely claim resolutions while maintaining the highest level of customer service and operational excellence.
Responsibilities:
- Document claims files accurately by capturing and updating data and information throughout the claims cycle.
- Analyze relevant facts and exercise sound judgment to determine liability, applying applicable laws and principles of negligence.
- Conduct policy verification and assess coverage to make determinations on claim validity under policy terms.
- Develop case strategies to drive timely claims resolutions, perform case evaluations, and escalate issues as necessary.
- Set and review reserves promptly and accurately within authority limits, estimating and validating claim values.
- Assess damages by calculating applicable amounts permitted by law.
- Negotiate claim settlements using effective strategies and tools within authority limits.
- Collaborate with internal and external stakeholders to meet quality standards and adhere to best practices.
- Direct counsel to guide litigation and settlement strategies for complex claims.
Basic Qualifications:
- Bachelor’s Degree and 6+ years of experience in Claims and/or Litigation Management.
Preferred Qualifications:
- 8+ years of experience handling high-severity and high-exposure Workers Compensation claims.
- 8+ years of experience in Litigation Management.
- Effective verbal and written communication skills.
- Strong analytical, critical thinking, and problem-solving abilities.
- Excellent multi-tasking and prioritization skills.
- Proven ability to collaborate in team environments and build cross-functional relationships.
- Deep understanding of insurance policies, financial trends, and reserving processes for complex claims.
- Expertise in leveraging data and trends to deliver high-quality customer service.
- Demonstrated ability to analyze complex claims and communicate coverage determinations effectively.
Benefits/Perks:
- Competitive salary and compensation package.
- Opportunities for professional development and career growth.
- Collaborative and supportive work environment.
