Sr Claims Rep

Found in: Resume Library US A2 - 2 weeks ago

Dallas Texas, United States H-E-B Full time
Responsibilities:
Job Summary: Conducts all necessary investigations in a timely manner on all types of claims and RTW cases to determine the facts and / or activities resulting in expenses related to the reported incident or case.

Essential Functions / Process Responsibilities (other duties may be assigned)
- Handles complex claims and investigations
- Provides ongoing training for assigned client groups
- Handles all escalated customer service issues
- Conducts investigations on all types of claims and RTW cases and provides recommendation for best course of action
- Reviews and interprets existing, new, or proposed OSHA regulations, updates to department staff as necessary
- Investigates and documents hazard reviews; analyzes, evaluates, and presents recommendations
- Coordinates litigation case management to ensure cost containment; attend trials when needed, reports on trial to management, ensures clear and concise communication between defense attorney and management
- Manage incident reports and determine appropriate action plan
- Communicates with all partners, customers and other third parties who have filed an incident report to determine an appropriate action plan and to provide the best possible customer service
- Reviews and evaluates reports of occupational injuries, determine eligibility, and administers any and all benefits due in accordance with the provisions of the Work Injury Benefit Plan
- Facilitates subrogation/recovery efforts from third parties responsible
- Coordinates the effective administration of the Return to Work Program
- Conducts more intensive investigations for referred cases
- Continuously reviews, sets, and monitors reserves to reflect appropriate levels of exposure
- Reviews and approves payments on all cases within assigned authority
- Ensure adequate reserving, communication, and effective resolution on attorney represented or litigated cases
- Serves as corporate representative, witness, etc.
- Facilitates property claims, work injury, general liability
- Instills a safety culture and supports all safety initiatives
- Serves as subject matter expert and acts as a resource for team members and assigned client groups all claim types
- Mentors others

Preferred Education and Experience
- A related degree or comparable formal training, certification, or work experience
- 5+ years of experience handling complex litigation case management, high valued cases, high risk cases that involve umbrella carrier, medical management on work injury cases, Return to Work program -, subrogation / recovery management, etc.
- Current Casualty Lines Claims Adjuster license (17-02) through the Texas Department of Insurance
- Valid Texas driver's license, no DUI, and no more than 2 moving violations in last 2 years

Preferred Key Competencies
- Comprehensive working knowledge of PPO utilization, communication with medical network, medical terminology, etc.
- Working knowledge of OSHA regulations
- Understanding of project management process
- Advanced customer service and telephone skills
- Advanced negotiating skills
- Intermediate PC skills, including MS Office and a Claims Management System
- Bi-lingual (English - Spanish) skills (preferred)
- Ability to interface with regulatory agencies, division and corporate staff, professional associations, etc.

Physical and Other Requirements
- Function in a fast-paced, retail, office environment
- Travel by car or plane with overnight stays
- Work extended hours; sit for extended periods
- Available for emergency contact 24 hours a day

LEG323

  • Sr Inside Sales Business Development Manager

    Found in: Resume Library US A2 - 1 day ago

    Austin, Texas, United States Allergan Aesthetics Full time

    Job Description About Allergan Aesthetics At Allergan Aesthetics, an AbbVie company, we develop, manufacture, and market a portfolio of leading aesthetics brands and products. Our aesthetics portfolio includes facial injectables, body contouring, plastics, skin care, and more. Our goal is to consistently provide our customers with innovation, education,...

  • Sr Software Development with C# and Vue JS

    3 weeks ago

    Dallas, United States Donato Technologies Inc Full time

    Job DescriptionJob DescriptionPosition: Sr Software Development with C# and Vue JS (Advisor Role)Location: RemoteDuration: 3 months with possible extensionExperience: 10+ yearsNOTES:5-7 years vue.js7-10 years of C#/SQL ServerESSENTIAL FUNCTIONS and RESPONSIBILITIESBecomes familiar with all aspects of the application, including reports, parameters, claims...

  • Project Manager

    1 week ago

    Dallas, United States Management Recruiters International Full time

    GLASS & GLAZING / FACADE PROJECT MANAGEMENTManagement Recruiters of Davidson is the premier Talent Acquisition firm specializing in the Glass and Glazing Industry. Our client is a recognized Glass & Glazing organization with a proven track record of success. If you are a dynamic Project Manager with strong glass and glazing / facade project management...

  • Sr. Workers Compensation Adjuster

    Found in: Appcast Linkedin GBL C2 - 2 weeks ago

    Dallas, United States SW Selective Search Group, LLC Full time

    Join an outstanding risk management group in North Dallas. We need a minimum of three years lost time claims experience settling claims in Texas and select other states. CAT injury experience preferred Join this boutique company with outstanding benefits, competitive salary, bonus, and so much more. Hybrid work schedule. Contact us for all the details.

  • Sr. Workers Compensation Adjuster

    1 week ago

    Dallas, United States SW Selective Search Group, LLC Full time

    Join an outstanding risk management group in North Dallas. We need a minimum of three years lost time claims experience settling claims in Texas and select other states. CAT injury experience preferred Join this boutique company with outstanding benefits, competitive salary, bonus, and so much more. Hybrid work schedule. Contact us for all the details.

  • Sr. Workers Compensation Adjuster

    Found in: Appcast Linkedin GBL C2 - 5 days ago

    Dallas, United States SW Selective Search Group, LLC Full time

    Our client isa insurance risk management group in North Dallas. Seeking a minimum of three years lost time claims experience settling claims in Texas and select other states. CAT injury experience preferred. Join this boutique company with outstanding benefits, competitive salary, bonus, and so much more. Hybrid work schedule.Contact our office for all the...

  • Project Manager

    2 weeks ago

    Dallas, United States MRINetwork Jobs Full time

    Job DescriptionJob DescriptionGLASS & GLAZING / FACADE PROJECT MANAGEMENTManagement Recruiters of Davidson is the premier Talent Acquisition firm specializing in the Glass and Glazing Industry. Our client is a recognized Glass & Glazing organization with a proven track record of success. If you are a dynamic Project Manager with strong glass and glazing /...

  • Sr. Inside Business Development Manager

    Found in: Resume Library US A2 - 2 weeks ago

    Austin, Texas, United States AbbVie Full time

    Job Description Job Title: Sr. Inside Business Development Manager Location: Austin, TX (HYBRID  schedule) Pay: Base + Sales Incentive Plans Type: Full time, direct hire Team: Inside Sales, Allergan Aesthetics Benefits: Paid Holidays, PTO, medical/dental/vision, matching 401k & much more!   ABOUT: The Allergan Medical Inside Sales Representative...

  • Sr Fraud Analyst II

    Found in: beBee jobs US - 1 week ago

    Dallas, Texas, United States Bank of America Full time

    Job Description:At Bank of America, we are guided by a common purpose to help make financial lives better through the power of every connection. Responsible Growth is how we run our company and how we deliver for our clients, teammates, communities and shareholders every day.One of the keys to driving Responsible Growth is being a great place to work for our...

  • Compounding Pharmacy Care Rep

    Found in: Resume Library US A2 - 2 days ago

    San Antonio, Texas, United States H-E-B Full time

    Responsibilities: H-E-B operates over 250 pharmacies throughout Texas, and our specialized Compounding Pharmacy creates and fills customized prescriptions for our patients. Joining the H-E-B Compounding Pharmacy team is an opportunity to make a difference, help people live healthier lives, and provide a level of service that extends beyond filling...

  • Compounding Pharmacy Care Rep

    Found in: Resume Library US A2 - 2 days ago

    San Antonio, Texas, United States H-E-B Full time

    Job Description: H-E-B operates over 250 pharmacies throughout Texas, and our specialized Compounding Pharmacy creates and fills customized prescriptions for our patients. Joining the H-E-B Compounding Pharmacy team is an opportunity to make a difference, help people live healthier lives, and provide a level of service that extends beyond filling...

  • Patient Access Rep II

    Found in: Resume Library US A2 - 2 weeks ago

    Bryan, Texas, United States CommonSpirit Health Full time

    Overview: CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our...

  • Sr. Analyst, Financial Reporting

    2 weeks ago

    Dallas, United States CareerBuilder Full time

    Share: Optimum Re Insurance Company / Dallas / Permanent / Full time You will contribute to the success of the organization by actively participating in the accounting, reporting process and production of financial reports. You will also support senior management with various requests and analysis. Main Areas of Responsibility: Coordinate and review...

  • Sr. Sales Operations Analyst

    Found in: beBee jobs US - 1 week ago

    Dallas, Texas, United States Proofpoint Full time

    It's fun to work in a company where people truly BELIEVE in what they're doingWe're committed to bringing passion and customer focus to the business.The RoleAs a Senior Sales Operations Analyst, you'll work with our sales and sales operations teams on reporting, forecasting, and providing general data-focused support for all stages and facets of the sales...

  • Manager, Account Management

    2 weeks ago

    Dallas, United States CareerBuilder Full time

    Role: Manager, Account Management Location: Dallas, Texas (Hybrid) Reports to : Sr. Manager, Account Management About Hippo: Our mission is to deliver intuitive and proactive protection for homeowners, combining the power of technology with a human touch. Hippo built the worlds first home protection platform. We believe that insurance should protect your...

  • Manager, Account Management

    2 weeks ago

    Dallas, United States Hippo Enterprises Inc. Full time

    Role: Manager, Account Management Location: Dallas, Texas (Hybrid) Reports to : Sr. Manager, Account Management About Hippo: Our mission is to deliver intuitive and proactive protection for homeowners, combining the power of technology with a human touch. Hippo built the world’s first home protection platform. We believe that insurance should protect your...