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Career Field
Claims
Insurance Discipline
All
Relocation Assistance
Not Available
Job Duration
Full Time
Salary Offered
Open
SUMMARY: Investigate, evaluate, negotiate and resolve claims. Satisfy customer needs and ensure file quality.
PRIMARY DUTIES: Provide voice-to-voice contact within 24 hours of first report. Handle low to moderately complex cases. Settlement authority will vary. Obtain facts to evaluate coverage, negligence, medical necessity and causation/damages. Identify subrogation opportunities; handle adverse subrogation and arbitration. Establish and maintain appropriate claim and expense reserves. Handle litigation on low-exposure cases. Develop litigation plan with staff or panel counsel, and track and control legal expenses; Review conciliations and prepare submissions for arbitration hearings. Assure cost-effective resolution. Provide quality customer service and control payout. Comply with state specific regulations. Recognize and forward appropriate files to SIU. Manage deductibles and wages. Recognize additional coverage issues (i.e. OBEL & XPIP) as well as jurisdictional issues. Manage medical payout and return-to-work strategies through IMEs and Peer Reviews. Perform any other duties as required.
EDUCATION/COURSE OF STUDY: College degree or equivalent experience preferred.
OTHER: Strong negotiation and customer service skills Medical terminology knowledge is helpful; able to learn data entry, retrieval & recordkeeping Completion of claim handling training program Strong organization and time management skills File Management Technical Customer Focus/ Communication Relationship Management Technology
