Workers' Compensation Claims and Risk Management Specialist

2 weeks ago

Palm Harbor, United States VESTED HR SOLUTIONS, LLC Full time

ABOUT US

Vested HR Solutions, LLC (“VHR”) is a Professional Employer Organization (“PEO”) headquartered in Palm Harbor, Florida and currently serving clients nationwide. VHR provides a suite of business solutions to clients through the PEO business model. Services include a cloud-based HR software and services platform, payroll, sponsored health and welfare benefits, workers compensation coverage and risk management among other services.

POSITION SUMMARY

Workers' Compensation Claims and Risk Management Specialist reports to the VP of Legal and Compliance. This position is responsible for workers' compensation claims management services, working with finance for underwriting clients per our workers' compensation underwriting guidelines, and assisting with safety and loss control services for identified clients.

ESSENTIAL DUTIES AND RESPONSIBLITIES

  • Service includes acting as a liaison between the injured worker, client and TPA responsible for adjudicating workers' compensation losses.
  • Detailed claims analysis, accident and subrogation investigation identifying red flags and potential fraud.
  • Assist in reserving practices, facilitating light duty, and oversight of both medical and legal.
  • Assist in evaluating claim value and coverage issues.
  • Mitigating claim severity and driving positive claim outcomes by leading our TPA towards claim resolution.
  • Responsibility to provide risk assessments to underwriting for new clients or new lines of business for existing clients.
  • Develop judgment to accept, reject or modify new and renewal business for workers' compensation insurance programs as needed while working with management.
  • Work with management to timely price clients according to underwriting and pricing guidelines.
  • Review and become familiar with policy coverages, agency relationships, underwriting and team guidelines, processes, and procedures, company business strategy and organization.
  • For select clients, evaluate the effectiveness of clients controls of the hazards and exposures associated with the clients’ operations.
  • For select clients, assist in their development of their safety program.
  • Assist in development of loss control level guidelines and document the results of all clients’ onsite inspections in accordance with the loss control level guidelines.

KNOWLEDGE, SKILLS AND ABILITITES

  • Excellent verbal, written, presentation, and interpersonal skills to interact with clients, carriers, and associates at all levels of responsibility is essential.
  • Understanding of professional and industry standards and practices.
  • Solid technical ability to identify, create and present data critical to loss control activities.
  • Highly motivated with a strong work ethic; able to work independently and with minimal supervision.
  • Proficient in Microsoft Word, Excel, and PowerPoint.

EDUCATION & EXPERIENCE

  • 5 + years of claims work experience required
  • 1 to 2 years underwriting experience preferred
  • Insurance or claims designation preferred
  • Minimum of 5 years' experience in safety and health
  • Previous Professional Employer Organization Experience a plus

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