Lead Claims Specialist

2 weeks ago


Springfield, Illinois, United States Acrisure LLC Full time
About Acrisure:

Acrisure stands as a prominent global leader in the Fintech sector, merging human expertise with advanced technology to deliver a diverse array of financial products and services to countless businesses and individual clients. Our mission is to connect clients with solutions that safeguard and enhance their most valued assets, including Insurance, Reinsurance, Cyber Services, Mortgage Origination, and beyond.

With a workforce exceeding 17,000 entrepreneurial professionals across 21 countries, Acrisure has experienced remarkable growth, escalating from $38 million to $4.3 billion in revenue over a decade. Our organizational culture is characterized by an entrepreneurial spirit, fostering innovation, client focus, and an unwavering determination to succeed.

Position Overview:

The Lead Claims Specialist is responsible for the independent adjudication of California workers' compensation indemnity, EL, and subrogation claims, primarily focusing on non-catastrophic cases.

Key Responsibilities:
  • Receives assignments for lost time claims, verifying coverage applicability. Engages in 24-hour communication with employers, employees, and attending physicians, utilizing telephonic contact, recorded statements, and in-person interviews as necessary.
  • Evaluates coverage issues and determines compensability in accordance with established standards.
  • Effectively manages all facets of the workers' compensation claims process, including litigation, while providing guidance to defense counsel.
  • Maintains strong customer relations, consistently building and nurturing trust and confidence with clients through regular communication, prompt responses, and resolution of inquiries and claim issues.
  • Responsible for setting reserves to Ultimate Probable Cost (UPC), ensuring reserves are aligned with anticipated exposure within authority limits.
  • Ensures timely delivery of benefits, including the issuance of benefit notices to injured parties as mandated by jurisdictional requirements.
  • Facilitates return-to-work (RTW) initiatives in line with the medical disability plan for injured workers.
  • Negotiates settlements directly with injured workers or opposing legal counsel.
  • Considers Medicare's interests regarding conditional payments and the eligibility of injured workers in settlements.
  • Identifies and manages third-party liability and subrogation opportunities for recovery.
  • Reviews medical and expense invoices for causal relationships and scrutinizes charges exceeding specified amounts.
  • Collaborates with Claim Supervisor/Claims Manager/Executive claims for assistance and consultation on complex files.
  • Completes Claim Status reports as required.
  • Assigns cases to nurse case management when appropriate, overseeing their billing and performance.
  • Coordinates claim review meetings with both internal and external stakeholders.
  • Attends hearings and depositions as necessary.
  • Performs additional duties as assigned.
Qualifications:
  • Exemplary telephone etiquette, strong verbal and written communication skills, active listening abilities, and excellent organizational skills.
  • Comprehensive knowledge of workers' compensation claims processes and policies.
  • Deep understanding of human behavior and motivational principles.
  • Ability to manage challenging issues effectively during stressful situations and in conflict-prone environments.
  • Proficient in computer applications, particularly the Microsoft Office Suite, with a typing speed of 45 WPM.
  • Basic understanding of business technology.
  • Adaptability to evolving business needs.
  • Capacity to perform well under pressure and multitask in a dynamic environment while maintaining attention to detail.
  • Commitment to ethical conduct and fair claims settlement practices.
Education and Experience:
  • Minimum Education: High School diploma or Bachelor's degree, along with 2-5 years of relevant experience.
  • Litigation experience is preferred but not mandatory.
  • Relevant state licensing or the ability to obtain licensing is required.
Benefits & Perks:
  • Competitive Compensation
  • Industry-Leading Healthcare
  • Savings and Investment Opportunities
  • Charitable Giving Programs
  • Hybrid Work Options
  • Growth Opportunities
  • Parental Leave
  • Generous Time Off
Acrisure is dedicated to fostering a diverse workforce. All applicants will be considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran, or disability status.
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