Workers Compensation Resolution Manager
1 week ago
We are a dynamic and collaborative team dedicated to delivering exceptional results for our clients. Our team members are passionate about their work and committed to excellence.Job Summary
We are seeking a highly skilled and experienced Sr. Claims Representative to join our claims team. The successful candidate will be responsible for independently investigating, evaluating, and resolving assigned claims of a more complex nature.
Responsibilities- Conduct thorough investigations of assigned claims, including gathering and analyzing evidence, interviewing witnesses, and reviewing medical records.
- Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable).
- Develop and implement effective action plans for case resolution, including medical and disability management, litigation management, negotiation, and disposition.
- Collaborate with PMA nurse professionals to develop and execute return to work strategies.
- Manage service vendors to achieve an appropriate balance between allocated expense and loss outcome.
- Stay up-to-date with jurisdictional requirements and applicable case law for each state serviced.
- Bachelor's degree or four or more years of equivalent work experience in an insurance-related industry required.
- At least 3-5 years' experience handling lost time workers compensation claims required; past experience with Vermont jurisdiction is required.
- Associate in Claims (AIC) Designation or similar professional designation desired.
- Active license required or ability to obtain license within 90 days of employment in mandated states.
- Familiarity with medical terminology and/or Workers' Compensation.
- Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously.
- Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details.
- Strong verbal, written communication skills, and customer service skills.
- Computer literacy, including working knowledge of MS Office Product Suite, i.e., Word, Excel, PowerPoint.
- Ability to travel for business purposes, approximately less than 10%.
The estimated salary for this role is $65,000 - $85,000 per year, depending on experience and location.
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