Workers' Compensation Senior Claim Representative - Eastern Alliance

About the role

This position supports our workers' compensation line of business, Eastern Alliance, and can be hybrid, reporting to our Carmel IN office location approximately two times per month, or remote in Kentucky. The primary responsibility is to consistently execute the Company’s ecovery® Return to Wellness philosophy and business model that leads to better outcomes for our injured workers and insureds.

You will manage all aspects of assigned claims, including verifying coverage, investigating, managing, and resolving complex workers’ compensation claims for the Company’s large customers under moderate supervision, following established Company requirements and procedures, and promptly establishing and maintaining accurate reserves with an authority limit of up to $75,000—all in support of the Company’s revenue and profitability objectives and overall business plan.

Responsibilities

• 35% – Complete ongoing claim management activities proactively and with a sense of urgency in accordance with the ecovery® Return to Wellness philosophy to execute the established plan of action and achieve favorable outcomes for all parties. Maintain, cultivate, and develop high-quality, collaborative working relationships with all parties, including injured workers, agents, customers, and co-workers. Maintain regular contact by telephone and correspondence. Seek complete information necessary to manage claims and achieve favorable outcomes. Respond to inquiries in a timely, courteous, and professional manner.
• 25% – Promptly investigate all assigned claims to establish trust and rapport with all parties, accurately assess coverage, determine the nature and extent of injuries sustained, and reinforce Return to Wellness expectations. Make fair and timely determinations of compensability. Demonstrate empathy, professionalism, integrity, and objectivity at all times. Prepare reports and forms as required by jurisdictional regulations and Company procedures. Promptly establish and maintain case reserves that accurately reflect anticipated financial exposure; revise reserves based on changes in facts and circumstances. Identify subrogation potential.
• 15% – Prepare claim status reports for customers, agents, underwriters, reinsurers, and others as needed. Attend point-of-sale presentations and claim review meetings with customers to serve claims and present reports.
• 15% – Manage Return to Wellness initiatives by working collaboratively with agents, clients, risk managers, and underwriters to ensure proper return-to-work guidelines and procedures are established, followed, and achieved.
• 5% – Prepare for and attend monthly large account team meetings; participate in discussions regarding results, profitability, and renewal strategy.
• 5% – Assist with company projects as assigned and continue professional growth and development through attendance and participation in insurance-related events, seminars, classes, and conferences.

Requirements

• A bachelor’s degree and a minimum of five years’ experience in workers’ compensation claims management, or a minimum of ten years working in a professional claims capacity in workers’ compensation without a degree; advanced certification or training is preferred.
• Comprehensive knowledge of applicable state laws and industry standards.
• Ability to independently attend insurance and industry/business functions to promote and present a positive image of the Company.
• Proficiency in Microsoft Office computer applications; ability to learn new computer software applications.
• Advanced analytical ability to analyze and interpret information and make appropriate decisions regarding claims payments.
• Excellent organization and time management skills.
• Excellent negotiation skills.
• Attention to detail in processing information, establishing priorities, and meeting deadlines.
• Excellent analytical and problem-solving skills, including formulating logical and objective conclusions.
• Ability to assess the urgency and importance of a situation and take appropriate action.
• Empathic listener with the ability to listen and respond in a way that engenders mutual understanding and trust.
• Ability to communicate effectively and professionally both verbally and in writing with various constituencies and at all levels, both in and outside the organization, including agency partners, customers, injured workers, and providers.

Benefits

Build your career with us and enjoy access to a best-in-class benefits program.

Pay

Position Salary Range: $66,229.00 – $109,289.00. The salary range displayed represents the entirety of the pay grade for this position. Most candidates will start in the bottom half of the range. Factors that may be used to determine your actual salary include your specific skills, years of experience, location, and comparison to other team members already in this role.

Schedule

This position can be hybrid, reporting to our Carmel IN office location approximately two times per month, or fully remote in Kentucky.