The Senior Workers Compensation Specialist/ Claim Specialist will have overall responsibility for implementing the Workers’ Compensation Claim Management duties.
Primary Functions/Basic Duties
- Encourages prompt claim settlement, file closure, and early return-to-work of insured employees;
- Evaluate needs and training client personnel in proper claim handling procedures;
- Evaluates insurer’s claims handling procedures and quality of claims personnel assigned to the account. Recommends changes where required.
- Tracks difficult or questionable claims to ensure that sub-rosa investigations are initiated, deadlines for depositions are met, doctors visits are monitored, hearing dates are not missed, and ensures other required activities claims are accomplished;
- Evaluates claim reserving practices of the insurer to ensure individual case reserves are established in a fair and realistic programs;
- Evaluates insurer billing and utilization review programs;
- Assists clients in properly utilizing the services of industrial clients and PPO networks.
- Ensure active pursuit of all subrogation possibilities;
- Review loss reserves prior to the insurer making a unit statistical filing to ensure that claims are closed whenever feasible and loss reserves are reported at the lowest practical amounts;
- Prepares prospective experience modification projections for clients.
- Excellent organization skills and the ability to plan well in advance for meeting with clients and insureds;
- Outstanding written and oral communication skills;
- Excellent presentation skills;
- High level of responsibility and the ability to work without direct supervision.
Knowledge: Excellent understanding of Workers Compensation loss reserves and various reserving methods used by insurers; excellent understanding of Workers Compensation laws and labor code.
Experience: 10 years
Ability to travel independently to client and carrier meetings on a regular basis as well as to industry conferences and seminars several times annually