Senior Claims Specialist, Workers Compensation

Job Summary

Process Workers Compensation Medical and Indemnity Claims, monitor Workers Compensation cases and direct attorney and outside vendors assigned to these claims.

Essential Job Functions

• Confirm coverage and policy information.
• Establish proper loss reserve, negotiate loss settlement (when applicable) and bring cases to resolution.
• Maintain control of outside vendors/attorneys and their expenses by directing assignments to them and limiting their scope to maximize cost effectiveness while minimizing delays in claims handling.
• Such vendors/attorneys must not be used unless pre-approved by the department manager.
• Maintain compliance with Workers' Compensation procedure and requirements established by regulatory authorities.
• Pursue Workers' Compensation liens and subrogation when appropriate.
• Maintain compliance with claims practice rules and internal instructions.
• Keep manager advised of significant developments in claims.
• Answer correspondence and inquiries promptly from brokers/agents, insureds, claimants, doctors, attorneys, outside vendors, TMA employees, etc.
• Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company.

Qualifications

• College Degree Preferred
• 5 to 10 years of experience handling Workers' Compensation claims for a major insurance carrier
• Must have applicable state licensing or the ability to obtain
• Knowledge of Workers' Compensation policy coverages
• Knowledge of coding related to claims technical matters
• Knowledge of legal, medical terms and meanings, civil and agency laws and related fields which may come within the purview of Workers' Compensation claims
• Ability to negotiate settlement/resolution of claims in a timely and reasonable fashion
• Proficient in Microsoft office
• Good oral and written communication skills

Pay

Salary range $105,000 to $120,000. Ultimate salary offered will be based on factors such as applicant experience and geographic location.

Benefits

We offer a comprehensive benefit package, which includes a generous 401K match.

Company Information

Our company offers a competitive benefits package and bonus eligibility on top of base.

Company Culture

TMA believes the perfect candidate is more than just a resume. If you don't meet every single requirement, but are still interested in the job, we encourage you to apply.

EEO Statement

Tokio Marine Management is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, or sexual orientation.