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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. 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
