Claims Representative III

Responsibilities

• Reviews, investigates, and makes decisions regarding coverage, compensability, and appropriateness of claims.
• Processes and documents claims to ensure compliance with company standards, industry best practices, and legislative provisions.
• Negotiates claim settlements up to designated authority level.
• Calculates and assigns timely appropriate reserves to claims and manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level.
• Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
• Prepares necessary state filings within statutory limits.
• Manages the litigation process; ensures timely and cost-effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
• Frequently communicates with all appropriate parties involved with the claim.
• Maintains professional client relationships.
• Executes appropriate claims activities to ensure consistent delivery of quality claims services.

Qualifications

• 3+ years of MD and DC workers compensation claims handling experience preferred.
• In-depth knowledge of appropriate insurance principles and laws of workers’ compensation, preferably jurisdiction specific.
• Strong written and verbal communication skills.
• Strong interpersonal, time management, and organizational skills.
• Strong negotiation skills.
• Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to detail.
• Ability to perform with a sense of urgency.
• Ability to work both independently and within a team environment.
• Ability to travel for business purposes, approximately less than 10%.

Benefits

• Base Salary Range: $70,000 – $85,000
• Eligible to participate in annual discretionary bonus.
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.