Staff Claims Workers Compensation Consultant

About the role

The Claims Consultant monitors and ensures consistency in claim handling guidelines, applicable laws, regulatory changes, state reporting, and overall claims practices and philosophy. This role conducts regular audits and communicates findings, supports claims operations through consulting and training, develops training materials, and leads training programs.

Responsibilities

• Uphold best practices and consistency in claims handling through a variety of audits to ensure uniformity in application of standards, guidelines, and practices;
• Perform individual and special audits as necessary;
• Analyze new and existing insurance laws, bulletins, and regulatory changes, then explain what those rules mean for underwriting or distribution strategy, appetite, product design, and workflows;
• Serve as a knowledge resource providing consulting guidance on laws, regulations, industry standards, and claims best practices, including coverage interpretation and claims philosophy, while identifying gaps where current practices may expose the company;
• Create and conduct training programs for both new hires and existing employees, collaborating with claims management on areas of opportunity. Develop training and resource materials, supporting current and emerging topics;
• Partner with management to identify, recommend, and implement changes in company policies, practices, and standards related to diverse claim, product, underwriting, or system requirements, facilitating acceptance and adoption;
• Develop and maintain reference materials supporting best practices;
• Monitor emerging trends and resources through active participation in external organizations and advise on opportunities to incorporate insights into Acuity practices and future business decisions;
• Participate in varied project work, including product innovation, process improvement through system design, as well as vendor and program evaluation, to maximize results;
• Proactively partner with stakeholders and the user community to advance new ideas and assure solutions meet customer needs and expectations;
• Support regulatory examinations, state audits, and data calls by ensuring accurate, consistent reporting and validation of information;
• Research, analyze, and resolve Claims EDI errors to ensure timely and accurate filings;
• Reconcile Claims EDI reports and state acknowledgment data to maintain data integrity;
• Partner with claims representatives to ensure required data elements are captured for proper Claims EDI filing, including guidance and training where needed;
• Display a positive, collaborative, and respectful attitude toward work, co-workers, the company, and others. Uphold Acuity core values and lead by example.

Qualifications

• Demonstrate knowledge of sound claims handling and coverage interpretation;
• Works effectively with stakeholders, customers, and resources from varied disciplines;
• Excel in verbal and written communications, and interpersonal interactions;
• Displays strong capabilities in critical thinking, analysis, and creative design. Willingly pursue innovative approaches and solutions;
• Effectively prioritizes, organizes, and accomplishes tasks in a self-directed environment;
• Experience with Claims EDI reporting and data exchange processes preferred;
• Knowledge of multi-state WC regulations and reporting requirements;
• Experience working with Claims EDI vendors and claim system integrations preferred;
• Familiarity with IAIABC standards and Claims EDI reporting guidelines preferred;
• Experience supporting or participating in system or process improvement initiatives preferred;
• Acuity does not sponsor applicants for U.S. work authorization.

Benefits

This job is classified as exempt. The salary range for this position is $90,000 - $125,000 annually. This salary range is an estimate, and the actual salary will vary based on applicant’s education, experience, knowledge, skills, and abilities. For this role, Acuity offers a comprehensive benefits package, including a generous 401(k) contribution, medical, dental, vision, life and disability insurance, paid time off, an Employee Assistance Program, and more.