As a Senior Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of an inventory of lost time and catastrophic workers’ compensation injury claims in multiple jurisdictions.

• Investigate workers’ compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due
• Calculate and set timely financial reserves and proactively manage reserve adequacy throughout claim lifecycle
• Record and code injured worker demographics, job information and accident information in company’s claims management system and files necessary forms with state regulatory agencies
• Issue timely payments to injured workers, medical providers and service vendors
• Coordinate and actively manage medical treatment of injured workers to ensure timely rehabilitation
• Negotiate settlements of claims within designated authority with injured workers and attorneys
• Serve as the team’s subject matter expert of the Workers’ Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictions
• Identify and manage subrogation, Second Injury Fund and joint coverage recovery opportunities
• Regularly communicate claim activity and status updates to policyholders, injured workers and other interested parties in a professional, thoughtful and tactful manner
• Notify management and develop reports for large exposure claims and comply with reinsurance reporting requirements
• Manage the claims litigation process to ensure timely and cost-effective claims resolution
• Monitor the expenses and effectiveness of managed care and investigation vendors

• Periodically travel to attend hearings, conferences and training sessions
• Attend and participate in claim file reviews with management and defense attorneys
• Coordinate and lead special projects or processes as assigned by management
• Assists with oversight and supervisory duties when the team supervisor is unavailable or as assigned by supervisor
• Support management with training and staff development
• Support management with vendor management activities
• Continuously strives to improve our product and business results through innovation
• Obtain and maintain adjuster license(s) in assigned jurisdictions

• 3 - 5 years of experience handling workers’ compensation claims
• Excellent written and verbal communication skills
• Strong interpersonal and relationship building skills
• Exceptional time management and organization skills
• Strong analytical and critical thinking skills
• Ability to work independently and strategically problem solve
• Ability to diplomatically manage conflict
• Ability to develop relationships within the organization and work effectively across departments
• Strong discretion and integrity in dealing with highly confidential and sensitive information
• Detail oriented

Education Requirement

• Bachelors’ degree or equivalent insurance industry work experience
• AIC, ARM, CCP, or CPCU insurance designation preferred