Job Description”This role is currently work-from-home and will move to the office environment after the COVID-19 restrictions are lifted.”Description:Requirements:
– 3 years of Workers’ Compensation Claims Experience, managing lost time claims.
– Must be licensed in the one or all of the following states: Texas, Colorado, Oklahoma, Alabama, Louisiana, Arkansas, Mississippi, Florida, Georgia, North Carolina, South Carolina, Arizona, UtahThe Claims Specialist works within a Claims Team, using the latest technology to review, analyze and process claims that are routinely characterized as moderately complex to complex within assigned authority limits.
This includes making decisions about compensability, evaluating losses, negotiating settlements and managing an inventory of established and new workers’ compensation claims.Responsibilities:
•Plans and conducts investigations of claims (including such activities as interviewing injured workers, witnesses and customers; collecting all necessary medical and accident materials to complete the investigation) to analyze and determine the mechanism of injury and compensability; determines need for, and engages medical resources to include nurse case managers and independent medical examiners.
Refers to claim to subrogation group or Special Investigations Unit as appropriate.
•Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.
•Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
•Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution.
•Acts as technical professional on team, assisting team members with escalated issues.
•Participates in file reviews and claim reviews with our customers as required.
•Performs other duties as assigned.Qualifications:
•3 years claims adjusting experience.
•Demonstrates an advanced to expert level knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the State’s Workers’ Compensation Laws.
•Excellent interpersonal skills to communicate and negotiate with customers and conduct investigations required.
•Leadership ability and demonstrated time management skills to delegate work appropriately and organize resources effectively.
•Required to obtain and maintain all applicable licenses.