REMOTE POSITION / CLAIMS PROCESSOR

If you're passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, 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! Our customers and partners are at the center of everything we do and we're looking for associates who are passionate about delivering extraordinary care.
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Do you have a strong desire to provide prompt, courteous and fair service to customers? 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.
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. 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. 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.
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. 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. Undergraduate studies in business administration or related field preferred and/or relevant Workers' Compensation experience.
Successful completion of required/applicable claims certification training/classes.
Three to five years prior experience in workers' compensation claims.
Advanced knowledge of insurance theory and practices, insurance contracts and their application. Familiarity with claims processing and claims best practices and procedures preferred. Proven knowledge of insurance contracts, medical terminology, workers compensation, and the legal aspects of court procedures affecting legal liability for all lines of insurance. Knowledge of claims systems. Excellent customer focus and proven ability to proactively meet customer needs. General knowledge of insurance theory and practices, insurance contracts and their application. Familiarity with claims processing and claims best practices and procedures preferred. Knowledge of insurance contracts, medical terminology, workers compensation, and the legal aspects of court procedures affecting legal liability for all lines of insurance. Knowledge of claims systems. Analytical skills necessary to make decisions and resolve conflict in such areas as application of coverage to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions. Ability to establish repair requirements and cost estimates for extensive losses and serves as a subject matter expert on respective claims projects. Demonstrates strong but flexible standards to balance the conflicting demands of the position. Demonstrated leadership capabilities to effectively train, coach, and provide feedback to less experienced associates.
Overtime Eligibility: Working Conditions: Normal office environment. May require ability to sit and use telephone and personal computer for extended periods of time. Must be willing to work irregular hours and to travel with possible overnight requirements. Must be available to work catastrophes (CAT) requiring travel to CAT site with multiple on-site responsibilities and/or for extended periods of time. We currently anticipate accepting applications until 08/13/2026. We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. claims
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For NY residents please review the following state law information: We value the partnerships we have built with our preferred vendors. 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; If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. Note on Compensation for Part-Time Roles: Please be aware that the salary ranges listed below reflect full-time compensation. Actual compensation may be prorated based on the number of hours worked relative to a full-time schedule.
The national salary range for Claims Specialist II, Workers Compensation : $69,500.00-$129,000.00
The expected starting salary range for Claims Specialist II, Workers Compensation : $69,500.00 - $103,500.00