Claims Specialist II, Workers Compensation (NE Region)

Job Summary

At Zurich North America Claims, we understand that work-life balance and flexibility are priorities when choosing your next career move. Our ZNA Claims hybrid work model is designed with employee needs in mind, emphasizing flexibility. This allows claims employees to conduct individual work in their preferred location while facilitating in-person connections and collaborative activities when meaningful and valuable. While the model provides a high level of flexibility and autonomy, occasional circumstances requiring in-office attendance should be expected.

Zurich is seeking an accomplished Workers Compensation Claims Specialist II for our Northeast region. This position offers a hybrid work schedule from our Parsippany or Boston offices, or a fully remote setup based in one of the following states: Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, or West Virginia.

The Workers Compensation Claims Specialist will handle multi-party commercial line Workman's Compensation claims of low to high exposure and complexity within specific authority limits, ensuring claims are handled efficiently and effectively while delivering customer-centric claims service.

Responsibilities:

• Document Claims: Accurately capture and update claims data/information in compliance with best practices for low to moderate exposure and complexity personal or commercial line claims.
• Determine Liability: Exercise judgment to determine liability by gathering and analyzing relevant facts, utilizing applicable law, and establishing basic principles of negligence.
• Verify Policy and Coverage: Determine policy verification and coverage by analyzing applicable coverage for claims and assessing if the loss falls within the coverage.
• Timely Resolution: Develop case strategy, case evaluation, and escalate issues as appropriate for timely claim resolution.
• Establish Reserves: Set timely reserves and perform ongoing reviews throughout the claims cycle within authority limits by estimating and validating claim values.
• Assess Damages: Calculate applicable damages or the range of damages allowed by law.
• Negotiate Settlement: Establish appropriate negotiation strategies and utilize available tools and resources within authority limits to settle claims.
• Meet Quality Standards: Adhere to best practices.
• Ensure Customer Service: Proactively communicate information, respond to inquiries, follow customer protocols, and potentially participate in customer marketing efforts.
• Manage Expenses: Work within approved vendor networks and manage the scope of work assigned to outside contractors. Depart from approved vendors with manager approval when in the best interests of the insured.
• Ensure Legal Compliance: Follow state and federal laws, regulations, and internal control requirements.
• Refer to Subrogation/Fraud Teams: Identify potential subrogation and fraud.
• Contribute to Profitable Growth: Provide risk insight, information, and trends to the Business Unit or customer as needed.
• Protect Zurich's Reputation: Maintain confidentiality of claims information.
• Maintain Knowledge: Stay current with industry trends, participate in educational opportunities, establish professional networks, and participate in professional societies.

Basic Qualifications:

• Bachelor's Degree and 3+ years of experience in Claims or Insurance; OR
• Zurich Certified Insurance Apprentice (Associate Degree) and 3+ years of experience in Claims or Insurance; OR
• Completion of Zurich Claims Training Program and 2+ years of experience in Claims or Insurance; OR
• High School Diploma or Equivalent and 5+ years of experience in Claims or Insurance.
• Must obtain and maintain required adjuster license(s).
• Knowledge of insurance regulations, markets, and products.
• Microsoft Office experience.

Preferred Qualifications:

• 4+ years of experience in Workers Compensation.
• 3+ years of experience in litigation management.
• Specialization in NJ, PA, VA, or WV jurisdictions.
• Ability to learn and handle additional jurisdictions as needed.
• EDI filing requirements.
• MSA/Medicare knowledge.
• WCCA, WCCP Designations.
• Claims handling knowledge and skills.
• Negotiation experience.
• Experience in line of business.
• Excellent communication skills.
• Analytical skills.

Compensation and Benefits:

Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. The proposed salary range for this position is $59,900.00 - $98,200.00, with short-term incentive bonus eligibility set at 10%.

We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here (https://www.zurichna.com/careers/benefits) .]

Why Zurich?

At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500®.

Join us for a brighter future—for yourself and our customers.

Equal Opportunity Employer:

Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy, or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets.

Zurich complies with 18 U.S. Code § 1033.

Note: Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal.

Location and Work Schedule:

• Locations: AM - Parsippany, AM - Boston, AM - Connecticut Virtual Office, AM - Delaware Virtual Office, AM - Maine Virtual Office, AM - Massachusetts Virt. Office, AM - New Hampshire Virt. Office, AM - New Jersey Virtual Office, AM - New York Virtual Office, AM - Pennsylvania Virtual Office, AM - Rhode Island Virtual Office, AM - Vermont Virtual Office, AM - Virginia Virtual Office, AM - West Virginia Virt. Office

• Remote Working: Hybrid

• Schedule: Full Time

• Employment Sponsorship Offered: No

• Linkedin Recruiter Tag: #LI-MD1 #LI-ASSOCIATE #LI-HYBRID

• EOE Disability / Veterans