Workers' Compensation Senior Claim Representative - Eastern Alliance
About The Position
An exciting opportunity exists to join the ProAssurance family of companies! ProAssurance specializes in healthcare professional liability, products liability for medical technology and life sciences, legal professional liability, and workers' compensation insurance. We are an industry-leading specialty insurer, with job opportunities in much of the contiguous United States. This position supports our workers' compensation line of business, Eastern Alliance, and can be hybrid, reporting to our Carmel IN office location approximately two times per month, or remote in Kentucky. The primary responsibility of this position is to consistently execute the Company’s ecovery® Return to Wellness philosophy and business model that leads to better outcomes for our injured workers and insureds. Responsibilities of this position include managing all aspects of assigned claims, including verifying coverage, investigating, managing, and resolving complex workers’ compensation claims for the Company’s large customers under moderate supervision, following established Company requirements and procedures, and promptly establishing and maintaining accurate reserves with an authority limit of up to $75,000 all in support of the Company’s revenue and profitability objectives and overall business plan.
Requirements
- A bachelor’s degree and a minimum of five years’ experience in workers’ compensation claims management or a minimum of ten years working in a professional claims capacity in worker’s compensation without a degree is required
- Comprehensive knowledge of applicable state laws and industry standards.
- Ability to independently attend insurance and industry/business functions to promote and present a positive image of the Company.
- Proficiency in Microsoft Office computer applications; ability to learn new computer software applications.
- Advanced analytical ability to analyze and interpret information and make appropriate decisions regarding claims payments.
- Excellent organization and time management skills.
- Excellent negotiation skills.
- Attention to detail in processing all information, establishing priorities and meeting deadlines.
- Excellent analytical and problem-solving skills, including formulating logical and objective conclusions.
- Ability to assess the urgency and importance of a situation and take appropriate action.
- Empathic listener with the ability to listen and respond to another person in a way that engenders mutual understanding and trust.
- Ability to communicate effectively and professionally both verbally and in writing with various constituencies and at all levels, both in and outside of the organization, including agency partners, customers, injured workers and providers.
- Ability to attend insurance and industry/business functions to promote and present a positive image of the Company.
Nice To Haves
- advanced certification or training is preferred
Responsibilities
- Complete ongoing claim management activities proactively and with a sense of urgency in accordance with the ecovery® Return to Wellness philosophy to execute the established plan of action and achieve favorable outcomes for all parties.
- Maintain, cultivate, and develop high quality, collaborative working relationships with all parties, including injured workers, agents, customers, and co-workers.
- Maintain regular contact by telephone and correspondence with all parties.
- Seek complete information necessary to manage claims and achieve favorable outcomes.
- Respond to inquiries in a timely, courteous, and professional manner.
- Promptly investigate all assigned claims to establish trust and rapport with all parties, accurately assess coverage, determine the nature and extent of the injuries sustained, and reinforce Return to Wellness expectations.
- Make fair and timely determinations of compensability.
- Demonstrate empathy, professionalism, integrity, and objectivity at all times.
- Prepare reports and forms as required by jurisdictional regulations and by the Company’s established procedures.
- Promptly establish and maintain case reserves that accurately reflect the anticipated financial exposure on each claim; revise reserves promptly based on changes in facts and circumstances.
- Identify subrogation potential.
- Prepare claim status reports for customers, agents, underwriters, reinsurers and others as needed; attend point of sale presentations; attend claim review meetings with customers as necessary to serve claims and present reports.
- Manage Return to Wellness initiatives by working collaboratively with agents, clients, risk managers and underwriters to ensure proper return to work guidelines and procedures are established, followed and achieved.
- Prepare for and attend monthly large account team meetings; participate in discussions regarding results, profitability, and renewal strategy.
- Assist with company projects as assigned and continue professional growth and development through the attendance and participation in insurance related events/functions, seminars, classes and conferences.
Benefits
- access to a best-in-class benefits program
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What This Job Offers
Job Type
Full-time
Career Level
Senior
