Claims Representative III

About the role

With over 35 years of proven expertise in the workers' compensation industry, Key Risk delivers innovative and responsive solutions that provide our clients the freedom to do what they do best. Offering guaranteed cost options to employers nationwide, Key Risk focuses on delivering products and services within specialized verticals to reduce workers' compensation exposures and deliver industry-leading results. All products and services are distributed through appointed insurance agents and brokers. Key Risk is a member company of W. R. Berkley Corporation, whose insurance company subsidiaries are rated A+ (Superior), Financial Size Category XV by A.M. Best Company and A+ (Strong), by S&P. For further information about Key Risk please visit www.KeyRisk.com

Responsibilities

• Analyze and manage complex workers’ compensation claims, including reviewing, investigating, and making decisions regarding coverage, compensability, and appropriateness of claims.
• Process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions.
• Act in a fiduciary role on behalf of policyholders, negotiate claim settlements, and handle claims in utmost good faith compliance with rules, regulations, and state statutes.
• Investigate and gather information to determine claim exposure.
• Negotiate settlement of claims up to designated authority level and make claims payments.
• Calculate and assign timely and appropriate reserves to claims and manage reserve adequacy throughout the life of the claim.
• Calculate and pay benefits due; approve all claim payments; and settle claims within designated authority level.
• Develop and manage claims through well‑developed action plans; continue to work the action plan to bring the claim to an appropriate and timely resolution.
• Prepare necessary state filings within statutory limits.
• Actively manage the litigation process; ensure timely and cost‑effective claims resolution.
• Coordinate vendor referrals for additional investigation and/or litigation management.
• Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
• Frequently communicate with all appropriate parties involved with the claim.
• Maintain professional client relationships.
• Actively execute 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%.
• Education: BA/BS Degree.
• Location: High Point, NC.

Benefits

Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.

Pay

Base Salary Range: $70,000-$90,000 Eligible to participate in annual discretionary bonus. 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.