Associate Claims Adjuster, Workers Compensation

About the Role

The Workers Compensation Claims Specialist works within a Claims Team under direct supervision, developing the knowledge and skills needed to conduct thorough investigations, make decisions about liability/compensability, evaluate losses, negotiate settlements and manage an inventory of commercial property/casualty and disability claims by participating in a comprehensive training program, one-on-one mentoring, and on-the-job training. Assists in providing service to policyholders/customers on mid-sized and/or large commercial accounts.

This position is open to be filled as an Associate Claims Specialist I (grade 10), Claims Specialist I (grade 11), or Claims Specialist II (grade 12) depending on candidate experience. This is a hybrid role with in-office attendance twice per month. Training requires travel for 1 week to Plano, TX in November.

Responsibilities

• Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (injured workers, customers, witnesses, etc.) to gather information regarding injuries or loss, refers tasks to auxiliary units as necessary, and posts file accordingly.
• Establishes action plans based on case facts, best practices, protocols, jurisdictional issues and available resources.
• Manages an inventory of workers compensation claims, evaluates compensability/liability and losses, and negotiates settlements within prescribed limits.
• Establishes accurate loss cost estimates using available resources, special service instructions, and market protocols.
• Confirms or denies coverage based on facts obtained during the investigation and advises policyholders as to proper course of action.
• Responsible for review, analysis, and disposition of assigned claims within authority limits and state compliance.
• Updates file, strategizes and executes plans to mitigate exposure and increase disposal.

Qualifications

• Effective interpersonal, analytical and negotiation abilities required.
• Ability to provide information in a clear, concise manner with an appropriate level of detail.
• Demonstrated ability to build and maintain effective relationships.
• Demonstrated success in a professional environment; success in a customer service/retail environment preferred.
• Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent.
• Knowledge of legal liability, insurance coverage and medical terminology are helpful, but not mandatory.
• Licensing may be required in some states.