Senior Workers' Compensation Claims Representative (Northeast)

Job Responsibilities

• The Senior Claims Representative will be responsible for, but not limited to:
• Investigate coverage, determine compensability, and manage a pending of Workers’ Compensation claims in multiple jurisdictions
• Proactively establish and update reserves throughout the life of the claim to reflect claim exposure and document supporting rationale
• Resolve claims within authority and make independent case value recommendations to senior leadership on cases which exceed authority
• Participate in reserving, pricing and strategy discussions with leadership
• Collaborate with outside defense counsel to effectively manage litigated files according to established litigation management guidelines
• Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills
• Ensure compliance with state and federal Workers’ Compensation regulations
• Provide exceptional customer service to policyholders, agents, injured workers, medical providers, legal, and vendors
• Document claim files in accordance with company and regulatory guidelines
• Identify subrogation potential and red flags that require SIU involvement
• Serve as a mentor to new and developing team members by providing ongoing coaching, technical guidance, and assisting with escalated issues
• Lead onboarding and training activities for newly hired claims representatives
• Partner with leadership to identify training opportunities, develop educational materials, and support continuous improvement initiatives within the Workers’ Compensation claims department
• Serve as a senior technical resource and mentor to less experienced claims representatives by providing guidance on complex claim issues, strategic decision-making, reserving, litigation management, and settlement evaluations.
• Maintain continuing education requirements
• Performs other duties as assigned
• Requirements

Qualifications

• Active adjuster license required
• 7+ years of experience handling litigated workers’ compensation claims
• Excellent organizational and leadership skills
• Experience with structured settlements and Medicare Set-Asides
• Ability to work in a fast-paced, collaborative, virtual office environment
• Strong analytical, organizational, and time management skills
• Excellent written and verbal communication skills
• Ability to work independently and meet assigned deadlines
• Strong negotiation skills
• Ability to multi-task and effectively prioritize tasks with frequent interruptions
• Proficiency with MS Word, Excel and internet applications
• Highly attentive to details
• Able to work under pressure and execute good judgment in sensitive situations
• Advanced verbal and written communication skills
• Demonstrated experience training, mentoring, or coaching claims professionals in a Workers’ Compensation environment

Education

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