ResponsibilitiesReview, evaluate, negotiate and processes WC Claims of moderate/severe/catastrophic complexity, provide recommendations and strategies for resolution, and litigation management as appropriate. Collaborate with internal and external clients, and often interact with agents, claimants, and policyholders. Responsibilities
- Analyze and process workers’ compensation claims by investigating and gathering information to determine compensability and exposure on claims, handling multiple jurisdictions.
- Calculate and assign timely and appropriate reserves on claims and monitor reserve adequacy throughout the life of the claim.
- Develop and manage claims updating action plans as the claim progresses and bring the claim to an appropriate and timely resolution.
- Accurately calculate and timely pay benefits due pertaining to the jurisdictional guidelines.
- Operate within designated authority level and time constraints pertaining to payments and settlements.
- File appropriate forms per jurisdictional protocol, within statutory limits.
- Actively manage and guide the litigation process, ensuring timely and cost-effective claims resolution.
- Participate in claim reviews, which may require limited travel, and timely production of claim reports.
- Coordinate vendor referrals for additional investigation and/or litigation management.
- Use appropriate cost containment techniques including strategic vendor partnerships to mitigate overall cost of claims.
- Manage claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
- Frequently collaborate with all appropriate parties involved with the claim, and clearly document that collaboration.
- Maintain professional internal and external client relationships.
- Actively execute timely and appropriate claims activities to ensure consistent delivery of quality claims services.
- Proactively manage all litigated claims by clearly documenting the litigation plan and budget, retaining competent counsel, communicating with counsel on a regular basis and clearly documenting the litigation action plan and strategy.
Qualifications
- Work experience in the WC Claims arena of at least 7 -10 years of end to end claims handling MA, VA, PA, MD, DC, WV, CT, DE.
- Must have extensive understanding of WC Statutory benefits and state regulatory requirements in multiple jurisdictions, with the capacity to learn new jurisdictions as needed.
- Adjuster license required in area of adjusting specialty.
- Working knowledge of Excel, Word, and general computer skills.
- Extensive understanding of WC Statutory benefits and state regulatory requirements in multiple jurisdictions.
- Ability to learn new jurisdictions as needed.
- Claims investigation and compensability analysis.
- Reserve management and claim resolution planning.
- Litigation management and vendor coordination.
- Client relationship management and collaboration skills.
Education
- Bachelors degree preferred
Additional Company DetailsWe do not accept unsolicited resumes from third party recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees including: • Base Salary Range: $92k-135k • Eligible to participate in annual discretionary bonus • Benefits include: Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and profit-sharing plans The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
