Claim Specialist II, III

This is a fully remote position, open to applicants in Florida.

📋 Description

• Engages with insured individuals, injured workers, agents, brokers, witnesses, attorneys, loss prevention specialists, and underwriters to gather and communicate essential information for assessing coverage/compensability, loss details, and liability/exposure levels.

• Manages the timely, appropriate, and accurate delivery of indemnity and medical benefits.

• Assesses claim exposure, negotiates, and resolves claims effectively.

• Collaborates closely with defense counsel on litigated cases and participates in mediation, arbitration, and hearings when necessary.

• Formulates a litigation strategy with defense counsel and monitors compliance with the plan to manage legal costs and ensure effective resolution.

• Works in partnership with insureds and employees by conducting visits and presentations as needed to enhance the claims handling approach.

• Maintains high-quality claim files in line with best practices and company procedures.

• Implements Managed Care strategies, coordinates rehabilitation or medical management, processes bills, reviews all correspondence through Image Right, and tracks progress as needed.

• Engages with State and Federal Boards and Commissions while setting and maintaining appropriate reserves.

• Acts as a mentor and assists in the training and preparation of less experienced Claim Department representatives.

• Stays informed on State laws and company procedures relevant to various claims; educates injured workers and/or insureds accordingly.

• Prepares and presents files for Agent/Broker Reviews and Insured File Reviews.

• Possesses knowledge of medical terminology and standard medical procedures related to worker’s compensation, U.S. Longshoreman’s, and Jones Act claims.

• Participates in both in-house and external training programs to remain current on pertinent issues/topics.

• Maintains proficiency with all computer systems currently in operation.

• Travels across States as necessary to manage assigned claims inventory.

• Pursues educational opportunities in claims through courses such as Associate in Claims or Claims Law (AEI).

⛳️ Requirements

• A minimum of three years of experience handling workers’ compensation lost time and medical-only claims is preferred.

• A Bachelor’s degree is preferred.

• Proficiency in computer applications, including Word, Excel, and Image Right is preferred.

• Must possess a valid driver’s license.

• Strong attention to detail and excellent communication skills, both verbal and written.

• Must be adaptable, flexible, and self-directed with the ability to manage time, multiple priorities, and other resources efficiently.

• Must demonstrate the ability to collaborate effectively with other organizational team members.

🏝️ Benefits

• Options for Health Insurance, Dental Insurance, and Vision Insurance.

• Employee Life Insurance/AD&D and options for Dependent Life Insurance.

• Short-term and Long-term Disability coverage.

• Health Savings Account with potential employer matching.

• Flexible Medical and Dependent Care Account options.

• Accident Insurance and Critical Illness Insurance.

• Employee Assistance Program available.

• Legal/Identity Theft Insurance options.

• Long Term Care Insurance and Pet Insurance.

• 401(k) Retirement Plan with a match up to 6%, plus an annual bonus based on individual and company performance.

• Five weeks of Paid Time Off (PTO).

• Eleven paid holidays.

• Flexible work schedules.

• Paid Parental Leave.

• Assistance for student loan paydown and refinancing.

• Educational support for job-related courses, seminars, certifications, or degrees.

• One paid day each year to volunteer for a non-profit of your choice.

• Sit-Stand desks and daily stretch breaks.