Senior Workers' Compensation Claims Representative

Berkley•Bedford, NH

8d•$95,000 - $105,000

About The Position

The Senior Workers’ Compensation Claims Representative is responsible for investigating, evaluating, and resolving assigned workers’ compensation claims in accordance with company standards, procedures, and state regulatory requirements. This role involves analyzing claim details, making compensability decisions, composing written communications, conducting investigations, evaluating exposures for accurate reserves, negotiating settlements, managing litigated files, retaining vendors, managing workloads to meet production goals, presenting cases in discussions, documenting file activity in a paperless system, reporting on claim trends, maintaining relationships with agency partners, and working proficiently with various computer programs. The position also requires attending training events, obtaining and maintaining state adjuster licenses, and performing other assigned duties.

Requirements

5 years of New Hampshire and/or Maine Workers’ Compensation Lost Time claims handling experience.
Valid NH WC adjuster license.
Excellent organizational skills with the ability to handle multiple tasks and effectively prioritize workload.
Demonstrated depth in negotiation and claims resolution skills.
Strong computer skills and ability to work with multi-faceted systems.
Ability to effectively and independently manage a complex workload while exhibiting very sound judgment.
Excellent written and verbal communication skills.
Demonstrated ability to develop and maintain relationships with agents and other departments while exemplifying superior teamwork.
Valid Driver’s License is required.

Nice To Haves

Advanced professional insurance coursework (i.e., AIC, CPCU) or completion of other insurance-related classes is preferred.

Responsibilities

Investigate, evaluate and resolve claims in accordance with company standards, procedures, and state regulatory requirements.
Analyze and determine specific facts of loss to reach appropriate decisions and effectively communicate the company’s compensability decisions.
Compose a variety of written communications to insureds, claimants, attorneys and agents in a professional and error-free manner.
Conduct detailed, comprehensive claim investigations including possible on-site scene examinations and in-person witness interviews when appropriate and necessary.
Evaluate and document exposure to ensure accurate and timely reserves; immediately escalate to management cases with significant exposure.
Negotiate effectively and in good faith to achieve fair and accurate claim settlements.
Proactively manage litigated claim files from inception to closure, including collaboration with defense counsel to determine and execute an appropriate plan of action; bring litigated cases to resolution either by negotiated settlement or hearing decisions, as appropriate.
Retain vendors to achieve appropriate claim outcomes while remaining mindful of loss adjustment expenses.
Manage assigned workloads effectively to achieve quality and quantity production goals while providing superior customer service.
Effectively present cases in roundtable discussions with peers and members of management at all levels.
Appropriately and clearly document all notes and file activity in a paperless claim system; compose detailed periodic reports including claim summary reports and large loss notifications.
Communicate with other departments regarding developments on specific claim files as well as overall claim trends relevant to Acadia’s business.
Maintain a strong relationship and frequent communication with Acadia’s agency partners.
Work proficiently with various computer programs including MS Word, Excel, and other applications used in the claim handling process.
Attend internal and external seminars and other training events and provide feedback to peers and/or members of management.
Obtain all required state adjuster licenses and maintain them as needed by complying with continuing education requirements.
Pursuit of industry-related professional designations is encouraged.
Perform other duties as assigned.