Senior Claims Professional

HOW YOU'D CONTRIBUTE TO THE TEAM

• Aids injured workers achieving rapid and full medical recovery and early, safe return to work through effective, efficient and timely medical treatment and return-to-work support.
• Effectively communicates with injured workers and employers. Demonstrates expertise and empathy, building trust and moving the claim forward, including timely three-point contacts on all new losses.
• Manages claims with an outcome-based and resolution focus. Demonstrates highly effective strategic plans for future handling that are well outlined in plans of action and followed through in a timely fashion.
• Demonstrates effective decision-making in compensability determinations and benefit authorizations (within designated authority parameters). Proactively utilizes resources such as Medical Management, SIU, Subrogation, Recovery, and Legal to ensure accurate determinations in compensability, causal relationship, appropriate medical treatment, and to achieve favorable outcomes.
• Prepares and maintains timely, accurate reserves on all claims for expected future costs of medical treatment, benefits, and other elements in accordance with Claims Handling Guidelines. Ensures reserves are escalated and approved as appropriate. Ensures there is appropriate reserve documentation in the file.
• Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
• Reduces fraud through early identification and escalation.
• Effectively manages defense attorneys. Demonstrates excellence in litigation management by being prepared for hearings in a timely manner and appropriately considering exposures, settlement options, and other legal issues.
• Reviews and approves vocational rehabilitation plans.
• Effectively manages vendors and providers. Identifies need for assignment and removal of vendors and makes effective use of vendor expertise while maintaining ownership of the claim.
• Demonstrates expertise in technical aspects of claim management. Works with Medicare Set-Asides, Structured Settlements, and/or Part B issues.
• Maintains effective relationships with internal and external service partners, including participation in periodic telephonic claims reviews.
• Calculates and pays benefits in accordance with the law. Ensures that the claim as a whole is managed in accordance with all legal requirements including the issuance of appropriate notices and filings.  
• Ensures continual education requirements are met.
 

WHAT YOU'D NEED TO QUALIFY:

• EDUCATION: High School Diploma or equivalent certificate required; Bachelor's degree from a four-year college or university preferred.
• EXPERIENCE: A minimum of five (5) years of indemnity adjusting experience managing large and/or complex workers' compensation claims and accounts required.
• Licensed to adjust workers’ compensation claims in one or more jurisdictions.  
• COMPUTER SKILLS: Proficient in Microsoft Office Suite applications and able to be proficient on applicable databases, Claims systems, and vendor software programs.

WHAT WE OFFER

• Manageable caseload with in-house Medical Management support (UR, Med Bill Review, Resource Nurses); In-house Claims Assistant support
• Work-Life Balance
• Work From Home Program (up to 2 days per week)
• Office Within Walking Distance of The Old Market
• Free On-Site Fitness Facility
• Garage Parking

BENEFITS

• Paid Time Off
• Paid Holidays
• Retirements Savings Match
• Group Health Insurance (Medical, Dental, and Vision)
• Life and AD&D Insurance
• Long Term Disability Insurance
• Accident and Critical Illness Insurance
• Flexible Savings Accounts
• Paid Community Volunteer Day
• Employee Assistance Program
• Tuition Reimbursement Program
• Employee Referral Program
• Diversity, Equity and Inclusion Program