Claims Specialist

Responsibilities

• Review, investigate, analyze and adjust claims in accordance with current laws and regulations.
• Report new incidents to the appropriate insurance carriers.
• Aid in risk transfer efforts, including drafting tender letters.
• Establish and maintain working relationships with claimants, employees, medical providers, Suffolk’s insurance broker, insurance carriers and outside defense counsel to ensure timely and accurate liability decisions.
• Determine when vendor involvement is necessary, such as medical case management, vocational rehabilitation counseling, legal, surveillance, etc. and direct and monitor the vendor services to ensure the effective cost containment of expenses on claims.
• Initiate “Three-Point Contact” with Suffolk’s insurance carrier(s), injured employee, and medical provider.
• Initiate, coordinate and ensure early return to work efforts.
• Review progress of claims internally, providing a well-documented action plan.
• Attend conferences, hearings, and mediations as necessary to properly administer resolution of claims.
• Perform monthly job-site visits to engage operations in the claims process, meet with employees and subcontractors, and perform site safety checks.
• Stay apprised of current changes in the law, court rulings and related matters that might affect the handling of claims.
• Act as an internal claims resource to assist with investigating and compiling data and financial information to support Suffolk’s position on claims.
• Participate in the administration of CCIP claims.
• Aid in discovery responses for litigated matters.

Qualifications

• Education: Bachelor’s degree
• Experience: 3-5 years of claims management experience or similar background in insurance industry and/or construction industry.
• Knowledge of workers’ compensation laws and guidelines (preferred)
• Knowledge of legal and medical terminology (preferred)
• Knowledge of insurance claims adjusting (preferred)
• Excellent working knowledge of Excel, Word and Power Point.

Attributes

• Actively participate as a team member within the Claims Department and with all departments within the company.
• Excellent written and verbal communication skills.
• Highly developed interpersonal skills.
• Ability to prioritize multiple demands in a fast paced, changing work environment.
• Initiative to meet designated time tables with minimum supervision.
• Detail oriented.

Working Conditions

• Sit for long periods of time.
• Talk or hear.
• Perform fine motor, hand and finger skills in the use of a keyboard, telephone, or writing.
• Frequent standing, walking, reaching with arms and/or hands.
• Specific vision abilities including close vision, distance vision, depth perception and the ability to adjust focus.
• Quiet to moderate noise level in an office environment.
• Job site walking.