Claims Representative III

We need to output HTML fragment with headings

for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We need to include only sections that have real specific content. The posting includes: - Company Details (some description). Could be "About the role"? Actually "Company Details" is about the company. The instruction: use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we need to map content to these headings. The posting includes: - Company Details (maybe "About the role"? Actually "About the role" is not present; we have "Company Details". Could treat as "About the role"? But they said do NOT repeat the job title as a heading (the page already shows it) and do NOT put Job ID / requisition numbers as headings — fold minor metadata into a short

or drop it. They gave examples of headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we need to decide which sections we have content for. We have: - Responsibilities: clearly present. - Qualifications: present (list of qualifications). Also there is "Education Requirement BA/BS Degree". That could be part of Qualifications. - Skills: not explicitly listed but qualifications include skills like communication, negotiation, etc. Could be a Skills section. - Benefits: present: "Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans." - Pay: present: "Base Salary Range: $70,000-$90,000 Eligible to participate in annual discretionary bonus." Also "The actual salary for this position will be determined by a number of factors..." So we have Pay. - Schedule: not mentioned explicitly. There's travel less than 10% but not schedule. So we should not create Schedule section. - Requirements: maybe we can treat Qualifications as Requirements? But they differentiate Requirements and Qualifications. The posting has "Qualifications" heading. Could map that to Qualifications. Requirements maybe not present separate; we could omit Requirements if no specific content. However they said "Prefer a few substantive sections over many thin ones." So we can combine. - About the role: we have Company Details description; could be used as About the role (description of company and role). The role description is in Responsibilities. But we could still have an About the role section summarizing the company and role purpose. The posting includes "Company Details" paragraph about Key Risk. That could be used as About the role (or About the company). We'll include About the role. Thus sections: About the role, Responsibilities, Qualifications (maybe also Skills), Benefits, Pay. We need to use

for each section heading. Use

• for any list of duties/requirements/benefits. Use

  for prose. We must preserve ALL substantive information; do not invent or summarize away detail. Remove boilerplate etc. We need to include details like location, travel, sponsorship not offered, etc. Those could be folded into a short

  maybe under About the role or separate? They said fold minor metadata into a short

  or drop it. So we can include location and travel in a short paragraph under About the role or maybe a separate "Details" but we don't have a heading for that. Could include in About the role paragraph. We must not repeat the job title as a heading. The job title is "Workers’ Compensation Claims Representative III". Not to be used as heading. We must not include Job ID/requisition numbers. We must not include cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. The posting includes "We do not accept unsolicited resumes from third party recruiting agencies or firms." That's maybe a requirement? Could be considered a requirement but it's a policy. Might be considered minor metadata; we could fold into a short p under Qualifications or Requirements. But we can include as a note. We must not include duplicated lines. Let's extract substantive content: Company Details paragraph: "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" That's about the company. Responsibilities bullet list (actually sentences). We'll convert each sentence to

• . List: - The Workers’ Compensation Claims Representative III is responsible for the analysis and management of complex workers’ compensation claims, including reviewing, investigating, and making decisions regarding coverage, compensability, and appropriateness of claims. - The position processes and documents claims to ensure compliance with company standards, industry best practices, and legislative provisions, acts in a fiduciary role on behalf of policyholders, negotiates claim settlements, and conducts the handling of claims in the utmost of good faith in compliance with rules, regulations, and state statutes. - 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 We need to ensure we don't duplicate. Some sentences may be overlapping; but we keep as is. Qualifications list: "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 Requirement BA/BS Degree" We need to split into items. Let's list: - 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 Requirement: BA/BS Degree We could also include "Additional Company Details" about compensation and benefits. Benefits: "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." Location and Travel: "Location and Travel: High Point, NC. Travel: Approximately less than 10% for business purposes." Sponsorship Details: "Sponsorship not Offered for this Role" We need to decide where to put location/travel and sponsorship. Could be a short paragraph under About the role or maybe a separate "Details" but we don't have heading for that. Could include in About the role after company description. We must not create Pay/Schedule/Benefits sections unless posting actually states them. We have Benefits and Pay, so include those. We must not create Schedule section. We must not create Requirements section if no specific content separate from Qualifications. We could omit Requirements. We must not create Skills section if we already have Qualifications covering skills; but we could still create Skills if we want to separate out skills like communication, negotiation, etc. However Qualifications already includes those. To avoid thin sections, we can combine Qualifications and Skills into one Qualifications section. That's fine. Thus sections: About the role, Responsibilities, Qualifications, Benefits, Pay. Now we need to output HTML fragment only, no /, no markdown. We'll produce:

  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. The position is based in High Point, NC and requires travel of approximately less than 10% for business purposes. Sponsorship is not offered for this role.

  Responsibilities

  • The Workers’ Compensation Claims Representative III is responsible for the analysis and management of complex workers’ compensation claims, including reviewing, investigating, and making decisions regarding coverage, compensability, and appropriateness of claims.
  • The position processes and documents claims to ensure compliance with company standards, industry best practices, and legislative provisions, acts in a fiduciary role on behalf of policyholders, negotiates claim settlements, and conducts the handling of claims in the utmost of good faith in compliance with rules, regulations, and state statutes.
  • 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
  • Us