Senior Claims Analyst

1 month ago

Springfield, United States Acrisure LLC Full time
About Acrisure:

Acrisure is a global Fintech leader that combines the best of humans and high tech to offer multiple financial products and services to millions of businesses and individual clients. We connect clients to solutions that help them protect and grow what matters, including Insurance, Reinsurance, Cyber Services, Mortgage Origination and more.

Acrisure employs over 17,000 entrepreneurial colleagues in 21 countries and have grown from $38 million to $4.3 billion in revenue in just over ten years. Our culture is defined by our entrepreneurial spirit and all that comes with it: innovation, client centricity and an indomitable will to win.

Job Summary:

The Senior Claims Analyst independently adjudicates California workers' compensation indemnity, EL and subrogation claim files that are generally non-catastrophic in nature.

Responsibilities:
  • Receives lost time assignments. Verifies and determines applicability of coverage. Completes 24 hour contact with employer, employee and attending physician inclusive of telephonic contact, recorded statements and/or in person interviews with insured, employee, physician, and witnesses.
  • Reviews all coverage issues and determines compensability within Midwest standards.
  • Aggressively manages all aspects of the workers' compensation claims management process inclusive of litigation, and providing direction to defense counsel.
  • Responsible for customer relations management, consistently establishing and maintaining high levels of trust and confidence with clients, through constant contacts, prompt response and resolving client's questions and claim issues.
  • Responsible for setting of reserves to Ultimate Probable Cost (UPC). Sets reserves for anticipated exposure subject to authority limits.
  • Addresses timely benefit delivery including production of benefit notices to the injured party as required in the applicable jurisdiction.
  • Coordinates return to work (RTW) in accordance with the medical disability plan for the injured worker.
  • Negotiates settlements directly with the injured worker or opposing counsel.
  • Considers Medicare's interests related to Conditional payments and injured workers eligibility and settlements.
  • Recognizes and manages 3rd party liability and subrogation through recovery.
  • Reviews medical and expense bills for causal relationship and bill charges over $1500.00.
  • Consults with Claim Supervisor/Claims Manager/Executive claims on files where assistance and consultation are needed.
  • Completion of Claim Status reports.
  • Makes assignments to nurse case management when indicated, monitoring their billing and performance.
  • Coordinate claim review meetings with both internal and external parties.
  • Attend hearings and depositions when required.
  • All other duties as assigned.
Qualifications:
  • Professional telephone demeanor, good verbal and written communication skills, good listening skills, along with strong organizational skills.
  • Thorough knowledge of workers' compensation claims procedures and policies.
  • Possess a strong understanding of human nature and motivation principles.
  • Readily control/handle problem issues in times of stress and in a climate of conflict and/or adversity.
  • Computer literacy including strong familiarity with Microsoft Office Suite. Ability to type 45 WPM.
  • Basic understanding of business technology.
  • Responsiveness to changing business needs.
  • Ability to work well under pressure and multi-task in a fast paced environment while continually paying attention to detail.
  • Ability to adhere to the code of ethical conduct and engage in fair claims settlement practices.
Education/Experience:
  • Minimum Education: High School diploma or Bachelor's degree and/or 2-5 years similar experience is required.
  • Litigation experience is preferred but not required.
  • Prefer relevant state licensing or ability to gain licensing is required
Benefits & Perks:
  • Competitive Compensation
  • Industry Leading Healthcare
  • Savings and Investments
  • Charitable Giving Programs
  • Offering hybrid work option
  • Opportunities for Growth
  • Parental Leave
  • Generous time away

#LI-KB1

Acrisure is committed to employing a diverse workforce. All applicants will be considered for employment without attention to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran, or disability status. California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at www.Acrisure.com/privacy/caapplicant.

To Executive Search Firms & Staffing Agencies: Acrisure does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered Acrisure's property, and Acrisure will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting Acrisure's Human Resources Talent Department.

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