Sr. Claims Examiner, WC

Harford Mutual Insurance Group•Bel Air, MD

9d•$72,000 - $103,500•Hybrid

About The Position

The Senior Claims Examiner investigates, evaluates, and resolves workers’ compensation claims and makes recommendations for resolutions from any of Harford Mutual Insurance Group companies. The incumbent will be expected to handle efficiently and competently medium to high severity claims, and to possess comprehensive knowledge of all coverages and claims handling procedures while providing quality claims service to policyholders and agents.

Requirements

Four-year college degree or comparable claims work experience; AIC or similar designation
5+ years’ experience in progressive claims roles
Experience handling MD workers’ compensation claims
Ability to understand and analyze policy coverages
Ability to analyze information to determine compensability

Responsibilities

Conducts prompt and thorough investigations of workers’ compensation claims within departmental and regulatory guidelines through telephone, written, and other communication methods with policyholders, claimants, attorneys, witnesses, and others with pertinent information.
Advocates for the injured worker and engages with nurse case management to mitigate lost time and facilitate a return-to-work.
Demonstrates specialized handling of lost time and lifetime medical cases with focus on long term cost-containment and injured worker advocacy.
Provides quality claims service to our policyholders and agents by remaining in constant communication with them throughout the claim lifecycle.
Evaluates coverage, determines compensability, utilizes negotiation skills to resolves claims within authority to include ability to draft the respective communications required on the claim.
Analyzes information to evaluate assigned claims to determine the extent of loss, taking into consideration coverage, compensability, and future investigation needs.
Assign and manage nurse case managers, defense counsel, or other experts on a task assignment basis where necessary.
Demonstrate in-depth understanding of workers’ compensation statutes, jurisdictional formwork, regulatory requirements, and changing legal landscape.
Accurately apply the HMIG reserving practice by continually evaluating claim exposure to establish appropriate and timely reserves over the life of the claim and notify claim management when exposure exceeds authority.
Maintain a claim diary and comply with departmental diary procedures.
Direct and handle subrogation and loss recovery efforts on assigned files.