Sr. Claims Specialist

4 weeks ago


Lake Worth, United States Advanced Dynamics Corp Full time
Job DescriptionJob Description

This is a remote position.

Job Title: Sr. Specialist, Claims

Classification: Salaried, Exempt (FTE)

Reports To: Director of Risk Management

Last Modified: 04/29/2024


Our client serves as a dedicated strategic partner to government and other clients. We seek to hire people who share our dedication to excellence, our passion for the work, and our commitment to a collaborative and inclusive work environment.


Summary:

The Sr. Specialist, Claims is responsible for managing workers’ compensation claims activity from conception to resolution.


Essential Functions:

· Manage Workers’ Compensation claims activity from conception to resolution, performing technical analysis and take proactive steps to mitigate claim cost.

· Maintain strong relationships with internal and external business partners.

· Review, approve or provide oversight of medical and miscellaneous invoices to determine if reasonable and related to designated claims.

· Negotiate with medical providers and third parties on self-insurance settlements.

· Coordinates and participates in strategic planning aimed at identifying developing trends with respect to type of loss, severity, and frequency.

· Communicates and interacts with medical professionals, carriers, operations, and HR partners to monitor and assess the progress of rehabilitation efforts, and to facilitate return to work.

· Lead and mentor peers on various claims processes/tasks.

· Work together with the Director of Corporate Insurance and Risk on other departmental and administrative duties as assigned.

· Other duties as assigned.


Knowledge and Skills:

· Proficient with Microsoft Office Suite.

· Thorough knowledge of the Workers’ Compensation coverage and process.

· Taking the initiative and being resourceful.

· Ability to use independent judgment and make appropriate insurance claims adjustment decisions and determinations.

· Excellent interpersonal communication skills.

· Conflict resolution and/or mediation skills.

· Ability to maintain confidentiality in matters involving personnel issues.

· Analytical and problem-solving skills.

· Attention to detail and ability to produce both standard and ad hoc reports.

· Adaptable to new concerns and changing environments.

· Ability to work flexible hours. We operate 24/7/365.


Education and Experience:

· Bachelor's degree in business administration, risk management, or a related field.

· 5+ years of experience handling workers compensation claims

· Workers’ Compensation Multi-jurisdiction, self-insured company and/or TPA and AIC or similar designation preferred.

· Proven experience working in full collaboration across multiple disciplines, both internal and external.

· Bilingual (English/Spanish) preferred.

· Must be authorized to work in the U.S. and able to travel within the Continental United States (CONUS).

· Must pass a background check after accepting a conditional offer of employment.


Supervisory Responsibility

This position will not have direct reports.


Work Environment- This position operates in a remote environment, seven days a week and holidays.

Travel - 10%





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