Claim Specialist III

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 attend 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 visitations and presentations as needed to facilitate partnership approach to claims handling.
• Maintains quality claim files in accordance with appropriate best practices, and other company procedures.
• Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor 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 the 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 and medical only claim handling experience preferred.
• 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.