As a premier workers’ compensation carrier, we are always mindful that behind every claim is a person who was injured, so an assembly line, rubber-stamp approach doesn’t work. Our claim management philosophy is to create pathways for the best possible results, whether the method is tried and true, or blazes a new path to success. This is The Zenith Difference. Under general supervision, responsible for the supervision and claims management of a claims unit. Provides technical guidance and training to personnel. Evaluates standards of performance of technical and clerical direct reports relative to branch/corporate objectives.
The essential functions of this position include, but are not limited to, the following:
- Directs, controls, monitors and provides technical and supervisory guidance to the assigned claims unit(s).
- Evaluates performance according to established, Zenith’s standards of performance. Prepares performance appraisals and recommends salary action for staff in unit in accordance with company policy.
- Participates in interview and hiring process and trains new employees assigned to unit.
- Responsible for claims management of cases assigned to unit, which may include special accounts, within the guidelines of published performance standards, company claim policy and regulatory requirements.
- Analyzes claims, sets reserves, determines liability, pays benefits and settles claims within designated dollar authority level and according to company policy and regulatory requirements.
- Makes timely investigation assignments and rehabilitation referrals including early return to work programs. Assigns cases to SIU as appropriate.
- Maximizes utilization of company medical cost containment programs.
- Prepares cases in litigation adequately and appropriately for MSCs and trials.
- Communicates with policyholders, injured workers and others in a professional and timely manner.
- May assist in preparation of agent status reports and policyholder claim reviews. May be assigned as account coordinator to large policyholders.
- Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
- Works productively and harmoniously with others on a consistence basis.
- Respond positively to direction and criticism of performance.
- Consistently maintain professional and appropriate demeanor.
- Perform other duties as assigned.
Education, Skills and Experience Requirements
- Bachelors degree or equivalent combination of training/experiencerequired.
- Minimum (6) years experience handling workers' compensation indemnity claims; to include settlement negotiation of litigated claimsrequired.
- Must demonstrate supervisory potential; previous experience or education acquired through seminars and classes preferred.
- Advanced knowledge of regulatory requirements and prevailing case law required.
- Excellent verbal and written communication skills necessary. PC literacy required.
- Good time management, organizational and negotiation skills a must.
- Meets all state regulatory standards regarding licensing, continuing education, and other requirements.
Bachelors or better.
6 years:Experience handling workers' compensation indemnity claims; to include settlement negotiation of litigated claimsrequired.