Senior Claims Specialist -
May be filled[Applicants: Be among the first 25 applicants | Industry: Insurance | Type: Full-time | Level: Mid-Senior level] Job DescriptionAs a member of our claims team, utilize your knowledge of Workers Compensation to…
Read full description
[Applicants: Be among the first 25 applicants | Industry: Insurance | Type: Full-time | Level: Mid-Senior level] Job DescriptionAs a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.ResponsibilitiesPromptly investigate all assigned claims with minimal supervision, including those of a more complex natureDetermine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)Alert Supervisor and Special Investigations Unit to potentially suspect claimsEnsure timely denial or payment of benefits in accordance with jurisdictional requirementsEstablish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposureNegotiate claims settlements with client approvalEstablish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and dispositionWork collaboratively with PMA nurse professionals to develop and execute return to work strategiesSelect and manage service vendors to achieve appropriate balance between allocated expense and loss outcomeMaintain a working knowledge of jurisdictional requirements and applicable case law for each state servicedDemonstrate technical proficiency through timely, consistent execution of best claim practicesCommunicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issuesProvide a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions...