Claims Specialist III- Workers Compensation

United Fire & Casualty • Cedar Rapids, IA

136d • Remote

About The Position

UFG is currently hiring for a Claims Specialist III to work with our worker's compensation team. This individual will be primarily responsible for verifying applicable coverages, conducting timely and thorough research of the facts of a loss, analyzing compensability and evaluating benefits for reserve and settlement, and negotiating medium to high complexity claims to resolution in accordance with claims best practices. The Claims Specialist III - WC role demonstrates a strong desire to learn and grow, promotes a positive work environment, and embraces a strong service-oriented mindset in support of internal and external customers. This role requires strong communication skills, attention to detail, and the ability to handle multiple tasks efficiently and effectively. It also requires the ability to work independently with a low level of supervision and a high level of accountability. A strong desire to advance one's professional development and the development of others is essential to this role. The ideal candidate will be bilingual in Spanish and English Languages and possess knowledge regarding Worker's Compensation for the state of CA.

Requirements

• High school diploma required.
• Post-Secondary education or Bachelor's degree preferred.
• Meet the appropriate state licensing requirements to handle claims.
• Within 1 year of hire, complete the Workers' Recovery Professional (WRP) certification program.
• Within 3 years of hire, complete the Senior Workers' Compensation Law Associate (SCLA) designation program.
• 5+ years of general work experience.
• 10+ years of workers' compensation claims handling experience or a combination of workers' compensation claims handling experience and experience in a related field.
• Bilingual in Spanish and English languages required.
• Proficient knowledge of insurance, medical and legal concepts is required.

Nice To Haves

• Willingness to pursue other professional certifications or designations as requested.

Responsibilities

• Review claim assignments to timely determine policy coverage, compensability of a claimed injury or illness and facilitation of medical, indemnity and other statutory workers' compensation benefits.
• Make prompt, meaningful contact with insureds and their employees to research facts by conducting interviews; securing, understanding and synthesizing information from relevant documents.
• Establish rapport and an outcome focused relationship with insureds and their employees, as well as other internal and external stakeholders.
• Request and analyze medical records to determine compensability according to evidence-based causation by jurisdiction.
• Interact with medical providers to clearly define medical causation and establish treatment plans focused on recovery.
• Promptly and supportively inform insured and employees as well as other stakeholders of coverage and compensability decisions.
• Support stay-at-work or return-to-work opportunities for insureds and their employees.
• Identify subrogation potential and document evidence in support of subrogation.
• Identify potential Medicare eligibility and comply with all Medicare Secondary Payor requirements of law.
• Assess and periodically re-assess the nature and severity of injury or illness and design a plan of action focused on recovery and resolution.
• Assess and periodically re-assess claim file reserves to a high degree of accuracy.
• Execute all technical claim handling functions such as documenting facts within the claims management system.
• Proactively seek resolution of claims by defining stakeholder outcome expectations early and often.
• Comply with statute specific claims handling practices and reporting requirements.
• Inform underwriting of increased hazards or unusual circumstances concerning a risk/policy exposure.
• Participate in internal and external continuing education opportunities to maintain licensure and develop claim handling skills and abilities.
• Demonstrate a supportive attitude and presence within the team by adapting well to change in process or procedure.

Benefits

• Remote work environment.
• Occasional irregular hours.
• Infrequent overnight travel and weekend hours may be required.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree