Claims Litigation Specialist

Position Overview:
The Claims Litigation Specialist operates under moderate supervision, overseeing the daily functions of the Claims Department, which includes essential reporting and customer technical assistance.

Key Responsibilities:
This role acts as a primary coordinator and Subject Matter Expert concerning programs, processes, and compliance with statutory and regulatory requirements.

The position provides general administrative support, including the compilation and preparation of fundamental information, data, and documentation for reports, presentations, and communications.

Operational Management:
The specialist demonstrates proficiency in utilizing and implementing office practices, software, machinery, procedures, and documentation.

Assists in the daily management and organization of programs and processes, ensuring adherence to statutory and regulatory compliance reporting across the claims organization. This includes identifying, researching, creating, and maintaining solutions, processes, training, and communications related to medical and cost containment programs.

Reporting and Collaboration:
Facilitates the completion of required jurisdictional monthly, quarterly, and annual reports for claims, collaborating with internal resources such as underwriting, financial reporting, corporate legal and compliance, claims legal, claims compliance, claims IT automation, and third-party administrators to ensure accurate and timely reporting.

Supports the Process Leader in developing, managing, and maintaining all processes, programs, and vendor relationships, recommending improvements and assisting with implementation.

Customer Experience Management:
Enhances the experience of customers, agents, claims professionals, and internal business partners associated with all processes. Communicates with new and renewal customers, often serving as the first point of contact to promote claims protocols, programs, and processes, while providing necessary documentation and materials.

Data Analysis:
Collects, organizes, and analyzes data related to claims processes to assist in managing these processes, creating reports, and communicating results with leadership for appropriate distribution.

Communication:
Identifies and completes both verbal and written communications regarding claims programs, processes, and compliance reporting with claims staff, internal and external business partners, customers, injured workers, agents, attorneys, regulators, project team members, claims leadership, and vendors.

Administrative Support:
Performs various administrative duties for the Claims Department and other Claims teams, including scheduling meetings, preparing meeting summaries, maintaining memberships, coordinating training, making travel arrangements, and organizing supplies and publications.

Maintains a working knowledge of and utilizes standard office equipment, including personal computers and appropriate software packages.

Qualifications:
2-4 years of experience in Insurance Claims or a related field is required. A High School Diploma or General Education Diploma (GED) and/or equivalent experience is also necessary.