Sr. WC Claims Specialist

2 weeks ago

Jacksonville, United States VensureHR Full time
About Us
Vensure Employer Solutions is the largest privately held organization in the HR technology and service sector, providing a comprehensive portfolio of solutions, including HR/HCM technology, managed services, and global business process outsourcing (BPO). The company and its service providers collectively serve over 95,000 businesses and process over $135B in annual payroll. As a "One Employer Solution" headquartered in Chandler, Arizona, Vensure helps thousands of businesses streamline and grow their operations with custom strategies that benefit both employers and employees. Find out more by visiting www.vensure.com .

Position Summary
Senior Worker's Compensation Claims Specialist position is responsible for servicing our Elite-level clients workers' compensation claims with minimal to no supervision required. This role requires that the associate monitor their assigned employers' workers' compensation claims, from inception thru closure, to ensure that all salient aspects of claim adjudication are being effectively and efficiently performed.

Essential Duties and Responsibilities
  • Service includes shadow adjusting and acting as a liaison between the injured worker, client and TPA responsible for adjudicating workers' compensation losses.
  • This involves ongoing detailed claims analysis, accident and subrogation investigation identifying red flags and potential fraud.
  • Additional responsibilities include accurate reserving practices, facilitating light duty, oversight of both medical and legal management.
  • Ability to evaluate settlement value and coverage issues.
  • Mitigating claim severity and driving positive claim outcomes by leading our TPA towards claim resolution.
  • Preparing and presenting strategic claim reviews with client and/or carrier.
Knowledge, Skills, and Abilities
  • Team player with exceptional customer service skills.
  • High work standards, results orientation and self-motivated.
  • Strong complaints handling, dispute resolution and ability to manage difficult situations.
  • Ability to meet deadlines and ensure all tasks are completed within service guidelines.
  • Ability to make sound decisions with confidence.
  • Strong analytical skills with an eye for detail.
  • Ability to effectively coach and assist Claims Specialists and Claims Associates.
Education & Experience
  • High School/GED, some college preferred.
  • 3+ years of insurance or claims work experience required.
  • 1-2 years of experience in complex claims.
  • Insurance or claims designation preferred.

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