Workers Compensation Senior Claims Specialist
Under moderate direction, handles a book of specialty lines claims, throughout the entire claim's life cycle. Responsible for conducting investigations, recommending adequate reserves, monitoring, documenting, and settling/closing claims in an expeditious and economical manner within prescribed authority limits for the line of business.
- Analyzes, investigates, and evaluates the loss to determine coverage and claim disposition.
- Utilizes CMS to document claims and to diary future events or follow-up.
- Within prescribed settlement authority for the line of business, establishes appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy.
- Makes recommendations to set reserves at appropriate level for claims outside of authority level.
- Prepares comprehensive reports as required. Identifies and communicates specific claim trends and account and/or policy issues to management and underwriting.
- Manages the litigation process through the retention of counsel.
- Adheres to the line of business litigation guidelines to include budget, bill review and payment.
- Monitors the case resolution process. Actively participates in mediations and arbitrations, within limit of settlement authority.
- Participates in Claims audit process.
- May provide claims marketing services by participating in meetings with brokers, risk managers and reinsurers.
- As required, maintains insurance adjuster licenses.
- Bachelors' and/or advanced degree. 5+ years claims/legal experience; or in a related field.
- Functional knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge.
- Functional knowledge of law and insurance regulations in various jurisdictions.
- Demonstrated strong verbal and written communications skills.
- Demonstrated strong negotiation skills.
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