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Personal Injury Claims Specialist

2 months ago

Irving, Texas, United States North American Risk Services, Inc. (NARS) Full time
Job Overview

Are you looking for a remote position that allows you to utilize your expertise in claims management? Do you have experience in handling complex claims and want to work in a supportive environment?

If this resonates with you, we have an excellent opportunity available.

  • Remote Work Opportunity
  • Full-Time Employment
  • Comprehensive Benefits Package (Medical, Dental, Vision, and More)
  • Company-Provided IT Equipment

A Personal Injury Claims Specialist is responsible for managing a caseload that reflects the complexity of the claims assigned. Key responsibilities include investigating incidents, determining coverage, coordinating medical treatment, managing legal proceedings, assessing damages, negotiating settlements, identifying fraudulent claims, and collaborating with authorized vendors.

Key Responsibilities:

Coverage Assessment:

  • Identify, evaluate, and confirm coverage details.

Client Interaction:

  • Establish initial contact with involved parties and clients within eight (8) business hours.
  • Engage with relevant parties and providers to assess liability, compensability, negligence, and subrogation potential.
  • Gather necessary information and explain benefits as appropriate, maintaining regular communication throughout the claims process.
  • Manage phone communications, check voicemail regularly, and return calls as necessary.
  • Assist in training and mentoring new Claims Specialists.
  • Support management with projects or temporarily fulfill assistant manager or manager duties as needed.

Subrogation Management:

  • Refer all files with subrogation potential to the appropriate department.
  • Maintain closing ratios as directed by management.
  • Ensure timely and complete closure of all files as appropriate.

Investigation Duties:

  • Verify facts of loss and relevant claims details, such as employment, wages, or damages, and establish disability with treating physicians as necessary.
  • Identify cases suitable for settlement.
  • Evaluate and negotiate liens.
  • Recognize and report potential fraud cases.

Litigation Oversight:

  • Develop and implement a litigation strategy with defense counsel (if assigned), utilizing all available defenses and tools to bring the case to resolution. Ensure timely completion of all filings and state-mandated forms.
  • Review claim files with active litigation on a monthly basis, documenting responses to filings, defense developments, depositions, and timely referrals to defense counsel.
  • Direct the actions of defense counsel on litigated claims.
  • Attend mediations and trials as required for effective litigation management.

Reserve Management:

  • Promptly establish ultimate reserves (anticipated costs to close the file based on known facts).
  • Ensure timely payment of all known benefits in accordance with state statutes.
  • Verify that all provider bills have been reviewed and paid within standard timeframes.

Reporting Obligations:

  • Report all serious injuries, liability issues, and potential large loss claims to clients and/or reinsurers based on established criteria.
  • Ensure compliance with all internal and external audits, including those conducted by regulatory agencies, carriers, and clients.
  • Adhere to reporting requests as outlined by client files and NARS guidelines.

Qualifications:

Education / Licensing:

  • High School Diploma or equivalent required; a 2-year degree or higher is preferred.
  • Experience with litigation is essential.
  • 3 to 9 years of prior claims adjusting experience or successful completion of the NARS Claims Trainee program is required.
  • Possession or ability to obtain a Florida Adjuster's license or other required jurisdictional licensing is necessary.

Technical Skills:

  • Strong interpersonal skills to manage sensitive and confidential situations and information.
  • Excellent negotiation and litigation skills for effective collaboration with attorneys and arbitration on first and third-party claims.
  • Ability to work independently.
  • Strong organizational and time management skills.
  • Exceptional written and verbal communication skills.
  • Ability to explain and respond to auditors, clients, and potential clients during in-person presentations.

Physical Abilities:

  • Ability to sit for extended periods.
  • Willingness to attend occasional local meetings.
  • Work indoors in environmentally controlled conditions.
  • May require lifting files and boxes weighing up to approximately 20 pounds.
  • Regular use of keyboard, mouse, computer, and exposure to computer screens.
  • Travel for mediation may be required as assigned.

In the spirit of pay transparency, we are pleased to share the base salary for this position, exclusive of fringe benefits or potential bonuses. This role is also eligible for an annual performance raise if all guidelines are met. Salary compensation will be determined based on factors such as geographic location, skills, education, and experience. Additionally, we emphasize the importance of pay equality and consider the internal equity of our current team members as a final aspect of any offer. Please note that the range mentioned is the full base salary range for the role, and hiring at the maximum of the range is not typical to allow for future salary growth. We also provide a generous compensation and benefits package.

Company Overview

North American Risk Services (NARS) is a leading third-party claims administrator committed to delivering optimal results for our clients. Founded in 1996, NARS manages claims for insurers, brokerages, managing general agencies, reinsurers, liquidation bureaus, self-insured funds, and various entities.

For more career opportunities and to learn more about NARS, please visit our website.