Claim Specialist II or III (NH & VT)

Principal Duties and Responsibilities

• 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, negotiates and resolves claims.
• Works closely with defense counsel on litigated cases and attends 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 visits and presentations as needed to facilitate a partnership approach to claims handling.
• Maintains quality claim files in accordance with appropriate best practices, and other company procedures.
• Implements Managed Care strategies, coordinates rehabilitation or medical management, processes bills, reviews all mail through Image Right, and monitors 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 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.

Minimum Knowledge, Skills And Abilities

• 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 a 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, multiple priorities and other resources wisely.
• Must have the ability to work effectively with other organizational team members.

Benefits

• Health Insurance options
• Dental Insurance options
• Vision Insurance
• Employee Life Insurance/AD&D and Dependent Life Insurance options
• Short-term & Long-term Disability
• Health Savings Account with potential employer match
• Flexible Medical and Dependent Care Account
• Accident Insurance
• Critical Illness Insurance
• Employee Assistance Program
• Legal/Identify Theft Insurance options
• Long Term Care Insurance
• Pet Insurance
• 401 (k) Retirement Plan with match up to 6%, plus annual bonus based on individual & company performance.
• 5 weeks of Paid Time Off (PTO)
• 11 paid holidays

Salary Range

Salary range is $80,000 - $98,000 depending on experience.

About the Role

The Claim Specialist II or III 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).

Qualifications

Candidates must have NH and VT claims experience, MA claims experience a plus.