Senior Claims Professional
2 weeks ago
WHAT WE'RE LOOKING FOR
BHHC has an immediate opportunity for an experienced Workers' Compensation Claims Professional. This position requires a self-starter who can work under a minimum of direction, achieve defined results, and accept ownership of their work product.
The Senior Claims Professional will be primarily responsible for the management of a caseload of workers’ compensation indemnity claims from inception to resolution. Responsibilities include initial investigation and analysis, strategic planning, management of medical care and legal process, and client relations.
HOW YOU'D CONTRIBUTE TO THE TEAM:
Helps injured workers achieve rapid and full medical recovery and early, safe return to work through effective, efficient and timely medical treatment and return-to-work support.
Effectively communicates with injured workers and employers. Demonstrates expertise and empathy, building trust and moving the claim forward, including timely three-point contacts on all new losses.
Manages claims with an outcome-based and resolution focus. Demonstrates highly effective strategic plans for future handling that are well outlined in plans of action and followed through in a timely fashion.
Demonstrates effective decision-making in compensability determinations and benefit authorizations (within designated authority parameters). Proactively utilizes resources such as Medical Management, SIU, Subrogation, Recovery, and Legal to ensure accurate determinations in compensability, causal relationship, appropriate medical treatment, and to achieve favorable outcomes.
Prepares and maintains timely, accurate reserves on all claims for expected future costs of medical treatment, benefits, and other elements in accordance with Claims Handling Guidelines. Ensures reserves are escalated and approved as appropriate. Ensures there is appropriate reserve documentation in the file.
Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
Reduces fraud through early identification and escalation.
Effectively manages defense attorneys. Demonstrates excellence in litigation management by being prepared for hearings in a timely manner and appropriately considering exposures, settlement options, and other legal issues.
Reviews and approves vocational rehabilitation plans.
Effectively manages vendors and providers. Identifies need for assignment and removal of vendors and makes effective use of vendor expertise while maintaining ownership of the claim.
Demonstrates expertise in technical aspects of claim management. Works with Medicare Set-Asides, Structured Settlements, and/or Part B issues.
Maintains effective relationships with internal and external service partners, including participation in periodic telephonic claims reviews.
Calculates and pays benefits in accordance with the law. Ensures that the claim as a whole is managed in accordance with all legal requirements including the issuance of appropriate notices and filings.
Inquisitive, critical thinker; agile learner with adaptive, smart time management skills
WHAT YOU'D NEED TO QUALIFY:
Bachelor's degree (B. A.) from a four-year college or university; or two to five years related experience and/or training; or equivalent combination of education and experience.
Licensed to adjust workers’ compensation claims in one or more jurisdictions. Self-Insured certification preferred.
To perform this job successfully, an individual should have expert skills in the following: Microsoft Word, PowerPoint, Excel, and be proficient on applicable databases, systems, and vendor software programs.
WHY YOU SHOULD APPLY:
Unparalleled financial strength and stability
Fantastic growth and advancement opportunities
WFH Hybrid schedule
Free gym in building
Generous Paid Time Off and Holidays
Excellent Benefits (Medical, Dental, Vision, 401k, etc)
Tuition Assistance Reimbursement
Discounts across companies such as GEICO, See’s Candies, etc.
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