Claim Specialist III

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

📋 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 facts, and liability/exposure levels.

• Ensures the timely, appropriate, and accurate provision 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 as required.

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

• Works in partnership with insureds and employees, conducting visits and presentations as necessary to promote a collaborative approach to claims management.

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

• Implements Managed Care strategies, coordinates rehabilitation or medical management, processes invoices, reviews all correspondence via Image Right, and monitors progress as needed.

• Engages with State and Federal Boards and Commissions, while properly establishing and maintaining reserves as appropriate.

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

• Stays informed about State laws and Company procedures regarding various claims; educates injured workers and/or insured parties accordingly.

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

• Possesses a solid understanding of medical terminology and standard medical practices related to worker’s compensation, U.S. Longshoreman’s, and Jones Act claims.

• Participates in both in-house and external training programs to stay abreast of relevant issues and topics.

• Maintains proficiency in all current computer systems used within the organization.

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

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

⛳️ Requirements

• A minimum of three years of experience in 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.

• A valid driver’s license is required.

• Strong attention to detail along with exceptional verbal and written communication skills is essential.

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

• Ability to work effectively with other team members within the organization is required.

🏝️ Benefits

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

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

• Short-term & Long-term Disability coverage

• Health Savings Account with potential employer match

• Flexible Medical and Dependent Care Accounts

• Accident Insurance

• Critical Illness Insurance

• Employee Assistance Program

• Legal/Identity Theft Insurance options

• Long Term Care Insurance

• Pet Insurance

• 401(k) Retirement Plan with a match up to 6%, plus an annual bonus 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 support for job-related courses, seminars, certifications, or degrees

• One paid day annually to volunteer for your chosen non-profit organization

• Sit-Stand desks and daily stretch breaks