Claims Representative III

Responsibilities

• Analyzes and processes workers’ compensation claims by investigating and gathering information to determine the exposure on the claim
• Negotiates settlement of claims up to designated authority level and makes claims payments
• Calculates and assigns timely and appropriate reserves to claims and continues to manage 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
• Actively 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
• Actively executes appropriate claims activities to ensure consistent delivery of quality claims services

Qualifications

• 3-5 years of workers’ compensation claims management experience
• Adjuster license strongly desired or ability to obtain license within six months
• 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 demonstrates 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%

Additional Company Details

We do not accept unsolicited resumes from third party recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full-time regular employees which for this role include: Base Salary Range: $70,000-$90,000 Eligible to participate in annual discretionary bonus. Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Pay

Base Salary Range: $70,000-$90,000

Schedule

High Point, NC. Travel: Approximately less than 10% for business purposes.