Workers' Compensation Specialist

Aegis•Jersey City, NJ

4d•$95,000 - $105,000•Hybrid

About The Position

AEGIS Insurance Services, Inc. (“AEGIS”) has an immediate opening for a Workers’ Compensation Specialist who will be responsible for overseeing an inventory of complex Workers’ Compensation claims at the excess level, managed by third party administrators and self-insureds at the primary level. Effectively manage assigned claims and provide appropriate advice to AEGIS and its Members relative to excess Workers’ Compensation matters.

Requirements

Minimum 3 years of relevant work experience with a carrier, third party administrator, or self-insured
Current experience should involve direct management of active Workers’ Compensation claims
Undergraduate degree or equivalent work experience
Applied knowledge of Workers’ Compensation claims, medical management procedures, medical cost containment programs and applicable laws and regulations
Proficiency with Microsoft Office: Specifically Word, Excel, and PowerPoint
Ability to effectively present to varied audiences
Ability to effectively negotiate large and/or complex claims

Nice To Haves

Experience managing Workers’ Compensation claims across multiple jurisdictions a plus
CWCP or equivalent Workers’ Compensation education or designations a plus

Responsibilities

Achieve timely and proper coverage analysis and verification, and communicate AEGIS’ coverage positions on assigned claims
Achieve timely, adequate, and accurate factual investigation of issues of compensability, subrogation and offset potential
Achieve timely and accurate evaluation of compensability
Achieve timely and adequate establishment of indemnity, medical and expense reserves (UNL and NUNL) reflecting AEGIS’ ultimate probable cost/exposure
Achieve timely and appropriate reporting to file, claims management and reinsurers, as needed
Keep abreast of developments in the law and their applicability and impact on AEGIS claims
Assist in the administration of the Workers’ Compensation Claim Review program
Monitor “long-tail” exposure claims to ensure recognition of AEGIS exposure and appropriate reserving
Provide timely advice, technical assistance and case management direction to insureds’ claim professionals and defense attorneys in the investigation, evaluation, negotiation, settlement and defense of claims and litigation, as appropriate
Conduct or participate in settlement negotiations in conjunction with insured’s personnel and counsel, when appropriate
Consult with Claims management and the Claims Review Committee, as required, in the evaluation and management of assigned claims
As directed, provide advice and guidance to other claims professionals within the Claims Division in the evaluation and management of claims, analysis of coverage issues and in the research and review of the various state and federal Workers’ Compensation statutes
Ensure the smooth operation of the Workers’ Compensation Department when Claims management team is unavailable
Assist in the development of policy and standards for the Claims Division
Foster and maintain good relationships with insureds, third party administrators, brokers and counsel