Manage within company standards and best practices complex and problematic high visibility workers’ compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim. Create action plans discussing exposure and reserve claims to reflect probable outcome. Experience in handling D.C. work comp necessary. Municipality experience a plus.
Essential Job Duties:
- Receives claim, confirms policy coverage and acknowledgement of the claim
- Determine validity and compensability of the claim by investigating and gathering information regarding the claim and file necessary documentation with state agencies.
- Establish reserves and authorize payments within reserving authority limits
- Develop and manage well documented action plan with the case manager and outcomes manager to reduce overall cost of the claim
- Coordinating early return-to-work efforts with the case manager and employer
- Manages subrogation of the claim
- Negotiates settlements when necessary
- Actively manage the litigation process
- Manage potential claim recoveries of all types
- Reports claims to the excess carrier
- Communicate claim status with the customer and claimant
- Adhere to client and carrier guidelines and participate in claims review as needed
- Develop and maintains professional customer relationship
- Requires regular and consistent attendance.
- Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (“IIPP”).
- Additional duties as required.
KNOWLEDGE & SKILLS:
- Excellent oral and written communication skills
- PC literate, including Microsoft Office (Word, Excel)
- Effective analytical and interpretive skills
- Strong organizational skills
- Good interpersonal skills
- Ability to work in a team environment
- Ability to work independently
- Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers’ Compensation
- Thorough knowledge of appropriate insurance principles and laws for workers’ compensation * Recoveries and offsets
- Four year degree at an accredited college or university preferred.
- Five (5) years of Workers’ Compensation claims management experience required.
- Experience in D.C. claims.