Claims - Workers Comp Claims Representative

Hanover Insurance Group, Inc.•Worcester, MA

35d

About The Position

Our Workers Comp Claims team is currently seeking a Claims Representative to join our Level One team in our Worcester, MA, Syracuse, NY, or Itasca, IL offices. This is a full-time/non-exempt role. POSITION OVERVIEW: Responsible for the investigation and resolution of complex medical only and lost time claims of low complexity in accordance with policy provisions, best practices and jurisdictional requirements. Includes the input of claim data and guiding insured's and claimants through the claim process and options.

Requirements

Typically has 1 - 3 years experience
Technical knowledge in WC coverages
Excellent written and verbal communication skills
Knowledge of medical terminology
Must possess organizational skills with regard to time management, task prioritization and integration of information from a variety of sources
Excellent and proficient data entry skills
High level of proficiency in Word, Excel and use of the Internet
Ability to meet and/or exceed the goals and metrics of the role on a consistent basis
Self-directed and self-motivated
Possesses strong customer service skills and behaviors
Makes decisions in an informed, confident and timely manner
Maintains constructive working relationships despite differing perspectives
Strong organizational and time management skills
Ability to negotiate skillfully in difficult situations with both internal and external groups
Demonstrates ability to win concessions without damaging relationships
Demonstrates strong written and verbal communication skills.
Promotes and facilitates free and open communication
Understanding of applicable statutes, regulations and case law
Thinks critically and anticipates, recognizes, identifies and develops solutions to problems in a timely manner
Easily adapts to new or different changing situations, requirements or priorities
Cultivates an environment of teamwork and collaboration
Operates with latitude for un-reviewed action or decision
Computer experience (MS Office, excel, word, etc)
Proficient using Claims systems (i.e. CSS, PMS, etc.)
Ability to use a personal computer and other standard office equipment
Ability to travel as necessary
Ability to sit and/or stand for extended periods
Workload requirements may routinely call for work hours in excess of 40 hours per week

Responsibilities

Must have or secure and maintain appropriate states adjuster license(s) and continuing education credits.
Work within specific limits and authority on assignments of moderate technical complexity.
Use discretion and independent judgment in claim handling.
Possess functional knowledge and skills reflective of fully competent practitioner.
Identify possibly suspicious claims.
Investigate, analyze, evaluate and negotiate personal and/or commercial lines claims of minimal to moderate complexity.
Responsible for managing all aspects of each claim and maintaining a high level of productivity, confidentiality and customer service.
Implement and coordinate the most effective management techniques to mitigate loss and expense payments.
Reserving and expense authority levels are moderate.
Work with the Special Investigations Unit, where appropriate.
May be required to have and maintain sufficient home-based internet connection.