Claims Representative III

Berkley•High Point, NC

13d•Onsite

About The Position

The Workers’ Compensation Claims Representative III is responsible for the analysis and management of complex workers’ compensation claims, including reviewing, investigating, and making decisions regarding coverage, compensability, and appropriateness of claims. The position processes and documents claims to ensure compliance with company standards, industry best practices, and legislative provisions, acts in a fiduciary role on behalf of policyholders, negotiates claim settlements, and conducts the handling of claims in the utmost of good faith in compliance with rules, regulations, and state statutes.

Requirements

3-5 years of workers’ compensation claims management experience
Adjuster license strongly desired or ability to obtain license within six months
In depth knowledge of appropriate insurance principles and laws of workers’ compensation, preferably jurisdiction specific
Strong written and verbal communication skills
Strong interpersonal, time management and organizational skills
Strong negotiation skills
Proven critical thinking skills that demonstrates analysis/judgment and sound decision making with focus on attention to detail
Ability to perform with a sense of urgency
Ability to work both independently and within a team environment
Ability to travel for business purposes, approximately less than 10%

Responsibilities

Analyzes and processes workers’ compensation claims by investigating and gathering information to determine the exposure on the claim
Negotiates settlement of claims up to designated authority level and makes claims payments
Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim
Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level
Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution
Prepares necessary state filings within statutory limits
Actively manages the litigation process; ensures timely and cost-effective claims resolution
Coordinates vendor referrals for additional investigation and/or litigation management
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims
Frequently communicates with all appropriate parties involved with the claim
Maintains professional client relationships
Actively executes appropriate claims activities to ensure consistent delivery of quality claims services