Claim Specialist III

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

📋 Description

• Investigate, assess, negotiate, and resolve lost time claims within the limits of settlement and reserving authority.

• Engage with insured individuals, injured workers, agents, brokers, witnesses, attorneys, loss prevention specialists, and underwriters to ascertain coverage, compensability, loss details, and liability/exposure.

• Administer timely, appropriate, and precise indemnity and medical benefits.

• Assess claim exposure and facilitate claims resolution.

• Collaborate with defense counsel on litigated cases; attend mediation, arbitration, and hearings as required.

• Formulate litigation strategies, monitor compliance, manage legal expenses, and support effective resolutions.

• Conduct visits to insureds and employees and deliver presentations as needed.

• Maintain high-quality claim files in accordance with best practices and company protocols.

• Execute managed care strategies, coordinate rehabilitation or medical management, process invoices, review correspondence through Image Right, and track progress.

• Interface with State and Federal Boards and Commissions and establish suitable reserves.

• Mentor and train junior Claim Department representatives.

• Stay abreast of state regulations and company claims procedures, educating injured workers and insureds accordingly.

• Prepare and present files for Agent/Broker Reviews and Insured File Assessments.

• Manage workers’ compensation, U.S. Longshoreman’s, and Jones Act claims utilizing appropriate medical terminology and procedures.

• Engage in both internal and external training programs.

• Maintain a working knowledge of company computer systems.

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

• Pursue ongoing claims education through Associate in Claims or Claims Law (AEI) courses.

⛳️ Requirements

• Candidates must possess claims experience in GA, VA, or TN.

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

• A Bachelor’s degree is preferred.

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

• A valid driver’s license is required.

• Exceptional attention to detail.

• Strong verbal and written communication abilities.

• Adaptable, flexible, and self-motivated.

• Capable of effectively managing time, multiple priorities, and resources.

• Ability to collaborate effectively with other team members within the organization.

🏝️ Benefits

• Health Insurance options, Dental Insurance options, and Vision Insurance.

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

• Short-term and Long-term Disability coverage.

• Health Savings Account with potential employer matching.

• Flexible Medical and Dependent Care Accounts.

• Accident Insurance coverage.

• Critical Illness Insurance options available.

• Employee Assistance Program.

• Legal/Identity Theft Insurance options.

• Long Term Care Insurance.

• Pet Insurance options.

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

• 5 weeks of Paid Time Off (PTO).

• 11 paid holidays.

• Flexible work schedules.

• Paid Parental Leave.

• Assistance with student loan paydown and refinancing.

• Educational assistance 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.