Workers Comp Resolution Specialist presso The Gray Insurance Company

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.