Workers Comp Resolution Specialist

In this role, you'll manage a diverse portfolio of moderate to high complexity workers compensation claims, drawing on your analytical, negotiation, and communication skills to drive effective outcomes. You'll collaborate with insureds, legal experts, and internal partners to deliver timely, fair, and customer-focused resolutions. We prioritize lower claims caseloads, typically half of the industry average, giving you the time and focus needed to deliver the meaningful resolutions our customers deserve. If you're looking for a role where your contributions are recognized, your growth is supported, and your work truly matters-this is your opportunity to make it happen with The Gray Insurance Company.

What you'd be doing:

Verify coverage and determine compensability

Investigate to determine benefit entitlement

Maintain standards with timely and clear communications with insureds, claimants, and plaintiff attorneys

Ensure prompt and accurate processing of medical, indemnity, legal, and vendor payments

Review and authorize medications, medical procedures, and IMEs/SMOs

Monitor and work with case managers, vocational rehab, and investigators

Assess exposure and set reserves within approved authority

Supervise and collaborate with defense counsel on litigated cases

Attend and participate in mediations and trials as required

Conduct timely file documentation, diary entries, and status reports

Visit insureds, attend meetings, and participate in file reviews

File EDI reports and jurisdictional mandated forms

Report suspected fraud and pursue subrogation opportunities

Ensure compliance with Medicare Section 111 and other applicable guidelines

Stay current on industry updates and maintain continuing education credits

Mentor team members and assist Branch Manager as needed We're looking for someone who has:

A valid adjuster license in applicable jurisdictions

At least 3 years of experience handling workers compensation claims

Excellent written and verbal communication skills

Strong proficiency with Microsoft Office and claims management software

Ability to manage a caseload independently and meet deadlines

Professional demeanor, keen attention to detail, and a team-oriented approach Preferred candidates may have:

Bachelor's degree

Experience supervising or mentoring peers

A background working on litigated claims

Experience participating in mediations and working directly with defense counsel

Industry designations (AIC, CPCU)

About The Gray Insurance Company:

Named among the Top Workplaces by the Times-Picayune for six years in a row, The Gray Insurance Company's mission is to provide innovative risk management solutions and positively impact the people we serve. We strive to be the leader in our market by changing how people think about insurance. We offer exceptional products and services and provide value through a workforce inspired to serve each other, our customers and our communities. Our core values are proud professionalism, responsive service, proactive improvement, integrity and, above all, family.

TGIC offers a comprehensive benefits package including robust health coverage, wellness coaching, 10 paid holidays, generous vacation time plus additional days of paid time off, paid volunteer time off, a 401k plan, profit sharing and more.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.