Claim Specialist III

Candidates must have GA, VA, or TN claims experience.

About the role

The Claim Specialist III investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.

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 to control legal expenses and assure effective resolution.
• Works closely with insureds and employees, making visitations and presentations as needed to facilitate a partnership approach to claims handling.
• Maintains quality claim files in accordance with appropriate best practices and 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.
• 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 workers' 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.
• Maintains a working knowledge of all computer systems currently in use.
• Travels throughout states as required to handle claims inventory assigned.
• Continues education in claims through Associate in Claims or Claims Law (AEI) courses.

Requirements

• 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.

Benefits

• Health, Dental, and Vision Insurance options
• 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/Identity 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
• Flextime schedules
• Paid Parental Leave
• Student loan paydown and refinancing assistance
• Educational assistance for job-related courses, seminars, certifications, or degrees
• One paid day every year to volunteer for your non-profit of choice
• Sit-Stand desks & daily stretch breaks