Job Details

Job Description:
Investigates, evaluates and proactively manages claims of varying complexity through final disposition. Addresses coverage and compensability issues. Handles lost time claims, including include high IWIS claims, high-exposure claims and claims for special accounts. Responsibilities also include medical case management, litigation management, return-to-work strategies and settlement where necessary. Serves as a resource and mentor to department members. Utilizes technology and systems for claims management, including document management, utilization review and pharmacy management. Claims are managed independently under general direction, following established policies, procedures and precedents.


Responsibilities:

• Serve as the dedicated claims representative for assigned accounts, ensuring customer service requirements are met.
• Proactively manage litigated claims with in-house legal or outside counsel, focusing on timely resolution and/or settlement.
• Evaluate and settle all claims with settlement potential within increased authority limits; present claims exceeding authority limits to executive claims committee for resolution of large exposure claims.
• Investigate and determine coverage, compensability, subrogation and second injury fund potential, resolving complex coverage issues involving multiple carriers or employer liability exposure.
• Manage occupational disease claims and other complex claims, including high IWIS and high-exposure claims.
• Effectively manage personal caseload to mitigate exposure while controlling claim costs.
• Develop cost containment strategies for large claims and recommend solutions for productive case outcomes.  
• Document claim files in compliance with quality review standards and complete reinsurance reporting on high exposure claims.
• Investigate larger, more complex workers’ compensation claims using sound-claims handling techniques in alignment with company claim philosophy and quality assurance standards.
• Establish and maintain appropriate reserves, accurately reflecting file exposure in accordance with company reserving procedures.

Requirements:

• Bachelor’s degree and four years of experience handling workers’ compensations claims or a high school diploma/GED with eight years of insurance claims handling experience, including four years in workers’ compensation
• 2+ years as a claims representative (preferred)
• CPCU, ARM, AIC (preferred)

Contact:
Alexandria Van Riper
avanriper@jacobsononline.com