Sr. Claims Specialist
3 weeks ago
This is a remote position.
Job Title: Sr. Specialist, Claims
Classification: Salaried, Exempt (FTE)
Reports To: Director of Risk Management
Last Modified: 04/29/2024
Our client serves as a dedicated strategic partner to government and other clients. We seek to hire people who share our dedication to excellence, our passion for the work, and our commitment to a collaborative and inclusive work environment.
Summary:
The Sr. Specialist, Claims is responsible for managing workers’ compensation claims activity from conception to resolution.
Essential Functions:
· Manage Workers’ Compensation claims activity from conception to resolution, performing technical analysis and take proactive steps to mitigate claim cost.
· Maintain strong relationships with internal and external business partners.
· Review, approve or provide oversight of medical and miscellaneous invoices to determine if reasonable and related to designated claims.
· Negotiate with medical providers and third parties on self-insurance settlements.
· Coordinates and participates in strategic planning aimed at identifying developing trends with respect to type of loss, severity, and frequency.
· Communicates and interacts with medical professionals, carriers, operations, and HR partners to monitor and assess the progress of rehabilitation efforts, and to facilitate return to work.
· Lead and mentor peers on various claims processes/tasks.
· Work together with the Director of Corporate Insurance and Risk on other departmental and administrative duties as assigned.
· Other duties as assigned.
Knowledge and Skills:
· Proficient with Microsoft Office Suite.
· Thorough knowledge of the Workers’ Compensation coverage and process.
· Taking the initiative and being resourceful.
· Ability to use independent judgment and make appropriate insurance claims adjustment decisions and determinations.
· Excellent interpersonal communication skills.
· Conflict resolution and/or mediation skills.
· Ability to maintain confidentiality in matters involving personnel issues.
· Analytical and problem-solving skills.
· Attention to detail and ability to produce both standard and ad hoc reports.
· Adaptable to new concerns and changing environments.
· Ability to work flexible hours. We operate 24/7/365.
Education and Experience:
· Bachelor's degree in business administration, risk management, or a related field.
· 5+ years of experience handling workers compensation claims
· Workers’ Compensation Multi-jurisdiction, self-insured company and/or TPA and AIC or similar designation preferred.
· Proven experience working in full collaboration across multiple disciplines, both internal and external.
· Bilingual (English/Spanish) preferred.
· Must be authorized to work in the U.S. and able to travel within the Continental United States (CONUS).
· Must pass a background check after accepting a conditional offer of employment.
Supervisory Responsibility
This position will not have direct reports.
Work Environment- This position operates in a remote environment, seven days a week and holidays.
Travel - 10%
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