Three years of experience in handling workers' compensation lost time claims.
Bachelor's degree preferred but not mandatory.
Proficiency in Word, Excel, and Image Right software.
Valid driver's license required for travel.
Strong attention to detail and excellent verbal and written communication skills.
Ability to adapt, be self-directed, and manage time effectively.
Collaborative mindset to work well with team members.
Responsibilities
Investigate and evaluate lost time claims within designated authority limits.
Communicate with various stakeholders to gather necessary information for claims assessment.
Administer timely and accurate delivery of indemnity and medical benefits.
Negotiate and resolve claims, collaborating with defense counsel on litigated cases.
Maintain quality claim files following best practices and company procedures.
Implement Managed Care strategies and coordinate rehabilitation efforts.
Mentor and train less experienced Claim Department representatives.
Benefits
Comprehensive health insurance options.
Retirement savings plan with company match.
Paid time off and holidays.
Professional development and training opportunities.
Flexible work arrangements.
Full Job Description
The Claim Specialist investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. (Supervisor will determine actual individual authority up to the stated maximum). Conducts training classes (including research and position papers) for less experienced Claim Department Representatives. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.
Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure. Maintains contact throughout the life of the file as needed.
Administers the delivery of timely, appropriate and accurate indemnity and medical benefits.
Evaluates claim exposure, negotiate and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary. Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.
Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling.
Maintains quality claim files in accordance with appropriate best practices, and other company procedures.
Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate.
Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate.
Serves as a mentor and helps prepare/train the less experienced Claim Department representatives.
Keeps up-to-date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same.
Prepares and presents files for Agent/Broker Reviews and Insured File Review.
Understands medical terminology and standard medical procedures as they pertain to worker's compensation, U.S. Longshoreman's and Jones Act claims.
Participates in in-house and outside training programs to keep up-to-date on relevant issues/topics.
Maintains a working knowledge of all computer systems currently in use.
Travels throughout States as required to handle claims inventory assigned.
Continues education in claims through Associate in Claims or Claims Law (AEI) courses.
Requirements:
Three years of workers' compensation lost time claim handling experience required.
Bachelor's degree preferred.
Computer skills, Word, Excel and Image Right preferred.
Must have valid driver's license.
Strong attention to detail and strong communication skills both verbal and written.
Adaptable/flexible and self-directed with the ability to manage time and other resources wisely.
Must have the ability to work effectively with other organizational team members.
Check out our benefit offerings here! Targeted salary range: $90,000-$115,000
