Workers' Compensation Claims Specialist

Summary:

Develop and maintain client relationships through advocacy on workers’ compensation and related issues. Perform claim reviews to ensure reserves are adequately set, claims files are moving toward closure, and communicate with client and claims professionals on a regular basis to achieve meaningful results.

Essential Duties and Responsibilities:

  • Develop and maintain relationships with clients and internal relationships to provide effective handling of workers’ compensation claims.
    • Maintain workers’ compensation client loss/claims files and provide updates as needed or agreed upon with Client Executives and clients.
    • Notify Client Executives of complex workers’ compensation claims and develop a strategy to work with the adjuster to resolve issues.
    • Ability to negotiate with workers’ compensation adjusters on behalf of clients to have positive outcomes related to claims.
    • Ability to negotiate/sell compensation claims services to prospects at Client Executive sales meetings.
    • Work with appropriate internal personnel to review all disputed or denied claims.
    • Maintain calendaring system for R&LA team including events for workers’ compensation clients with dates critical to unit statistic filings.
  • Assist in business development
    • Participate in occasional sales and service meetings at the request of Client Executives and clients.
    • Keep abreast of the industry through independent study, seminars and community resources.
    • Provide written communication to associates and clients in reference to key occurrences within the workers’ compensation industry. This is done through articles, emails and “Breaking News” pieces.
    • Participate in workers’ compensation related seminars and training.

Education and/or Experience

Successful candidate will be a service oriented individual with high personal standards and a hands-on work style. This position requires an individual who is comfortable working at a varying pace, managing multiple tasks and deadlines simultaneously, adjusting priorities often, and managing frequent interruptions.
This position interacts with and provides service to a large group of internal associates and has high levels of contact with external vendors. The Workers’ Compensation Claims Specialist must be positive and approachable, and work effectively with diverse personalities. In addition, the following is required:

  • Successful work history to include 4 years workers’ compensation claims management or relevant insurance industry experience.
  • Bachelor degree strongly preferred.
  • Proficiency with personal computers and Microsoft Office applications with the ability to operate standard office equipment is required.
  • Skill in organizing resources and establishing priorities.
  • Demonstrated ability to resolve problems and present results neatly, with clarity and precision in oral and written form.
  • Demonstrated ability to develop, plan, and implement short- and long-range goals.
  • Maintain a valid California Driver’s License & have reliable transportation.

Work Environment & Physical Demands

  • Ability to use computer keyboard and sit in a stationary position for extended periods.
  • Work is performed in a typical interior/office work environment.

 

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