Reports to the Vice President and Senior Vice President, Claims
Summary and Purpose
Investigate, manage and resolve claims in a timely, unbiased and informed manner in compliance with company policies, state laws and regulatory performance standards.
- Knowledge of policy documents for coverage verification.
- Provide account servicing support on claim issues to policyholders.
- Investigate, determine compensability, and manage time loss claims consistent with jurisdictional requirements.
- In-person meetings with injured workers, employers, and medical providers
- When necessary, assign investigators, attorneys, medical consultants and others to facilitate claim determinations and plan of action.
- Follow up with claimants, policyholders and medical providers to monitor progress.
- Answer questions regarding the status of pending claims from claimants, policyholders and medical providers.
- Consult with attorneys regarding litigation management, settlement strategy and claim resolution.
- Assist clerical staff in completion of workers' compensation forms in conformance with jurisdictional requirements.
- Maintain electronic and paper files necessary for documentation of the claim file to include coding, contacts, financial data and plan of action.
- Review reserves for appropriateness and file timely reports on all serious loss claims as required by policy and regulatory standards.
- Participate in department training.
- Provide direction and supervision to assigned clerical staff.
- Perform other duties as assigned.
- High school graduate, college degree preferred
- Two years of college courses or equivalent industry experience
- One year of Workers' Compensation adjusting experience
- Fundamental knowledge of maritime and USL&H jurisdictions
- Knowledge of medical and legal terminology and procedures
- General computer skills
- Excellent written and verbal communication skills
- Strong inter-personal skills
- Effective negotiation skills
- Ability to prioritize workload to meet deadlines
- Ability to work well in a team environment