Litigation Specialist - Workers Compensation

Overview

This role investigates, evaluates, and resolves complex and litigated workers’ compensation claims to support prompt and appropriate outcomes. You will administer and resolve claims in a timely manner in accordance with legal statutes, policy provisions, and organizational guidelines, while providing a high level of service to internal and external partners.

Responsibilities

• Promptly evaluate assigned claims and establish/execute strategies to mitigate exposure related to indemnity, medical, and allocated loss adjustment expense.
• Ensure timely disposition of claims in accordance with regulatory and statutory requirements.
• Track the status of assigned claims individually and in the aggregate using management reports and tools such as Excel. Monitor information including:
  • Permanency evaluations
  • Hearing dates
  • Attorney information
  • Settlement evaluation
  • Venue, judges, current litigation status
  • Subrogation credits due
  • Overall financial outcomes
• Within granted authority, ensure appropriate loss and expense reserves are established with documented rationale.
• Maintain and adjust reserves over the life of litigation to reflect changes in exposure, complying with the reserve authorization process.
• Notify appropriate claim management when exposure exceeds authority.
• Negotiate claim resolutions within granted authority.
• Establish and execute action plans for claim resolution, including loss cost management, while maintaining an appropriate financial balance between allocated expense and loss outcomes.
• Collaborate with internal and external professionals and business partners to reach appropriate claim dispositions.
• Select and manage service vendors to support an appropriate balance between allocated expense and loss outcome.
• Maintain strong working knowledge of applicable regulatory and jurisdictional requirements.
• Demonstrate technical proficiency through timely, consistent execution of best claim practices and established claims-handling guidelines.
• Communicate effectively with internal and external stakeholders regarding claims and account issues, providing a high level of customer service.
• Maintain and manage a diary system and claim pending to efficiently and effectively resolve claims.
• Manage litigation to achieve appropriate financial outcomes, including effective management of defense counsel to protect the insured and organizational interests.
• Participate with claims management in evaluating staff and panel counsel, and make recommendations for addition/deletion of counsel.
• Travel regionally for attendance at hearings and trials (as needed).
• Demonstrate commitment to the organization’s Code of Business Conduct and Ethics and apply compliance policies, procedures, standards, and laws applicable to job responsibilities.

Qualifications

• NY License required.
• Minimum of 7 years of progressively responsible experience handling NY complex workers’ compensation claims and workers’ compensation litigation.
• Strong expertise in commercial workers’ compensation coverage, evaluation, and negotiation techniques.
• Strong organizational skills and attention to detail.
• Ability to work independently, prioritize workload, manage multiple tasks simultaneously, and exercise good judgment.
• Working knowledge of workers’ compensation claims handling practices.
• Excellent verbal and written communication skills, including the ability to lead or participate in meetings, presentations, and seminars.
• Excellent customer service skills with emphasis on accessibility and responsiveness.
• Computer literacy, including experience with Word, Excel, and PowerPoint.
• Strong litigation management skills and extensive knowledge of applicable regulations, legislation, and judicial decisions in relevant jurisdictions.

Preferred Qualifications

• Bachelor’s degree desired.

Compensation & Benefits

• Anticipated wage range: $84,000 to $100,000.
• Wage ranges are based on national market data and may cover a wide range of geographies. Applicants may be paid above, within, or below this range based on various factors.

Location

• #LI-Remote
• Potential regional travel for attendance at hearings and trials.