Technical Claims Spec II, WC

Description

Under limited supervision and established practices, responsible for the investigation, evaluation, and disposition of Complex Workers Compensation cases of high exposure and severity. Applies established medical management strategies on high dollar complex claims. Has developed high level of knowledge of Workers Compensation claims handling techniques, a full knowledge of LMG claims procedures and is cognizant of new industry trends and claim handling techniques Uses available data to track claims trends and other claim related metrics.

 

Remote role. If you live within 50 miles of a USRM hub location, in-office presence is required twice per month.

 

This is a grade 14-15 range posting depending on experience and qualifications.

****** Primary jurisdictions - FL, SC, NC, AL, GA, MS. *******

Responsibilities:

• Investigates claims to determine whether coverage is provided, establish compensability and verify exposure.
• Resolves claims within authority and makes recommendations regarding case value and resolution strategy to Branch Office Management and HO Examining on cases which exceed authority.
• Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management.
• Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols. Identifies and appropriately handles suspicious claims and claims with the potential to develop adversely. Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure.
• Establishes and maintains accurate reserves on all assigned files.
• Makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority.
• Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insureds.
• Demonstrates the ability to understand new and unique exposures and coverages.
• Demonstrates the ability to understand key data elements and claims related data analysis.
• Confers directly with policyholders on coverage and resolution strategy issues. Coordinates and participates in training sessions for less experienced staff, including both Complex non-Complex staff.

Qualifications

• A Bachelors degree or equivalent business experience is required
• In addition, the candidate will generally possess 5-7 years of Workers’ Compensation claims experience with 1-2 years of experience in complex claims
• Proven negotiation, litigation management, and analytical skills
• Excellent communication, organization, and decision-making abilities

Licensing:

• May require state-specific claims adjuster licensing; candidates must hold (or be able to obtain and maintain) all necessary licenses for FL, SC, NC, AL, GA, MS and other states based on business need.

Employees may apply for a new role after completing 12 months of employment in their current position.

 

Employees should review all role requirements and apply only for positions for which they are eligible. Hiring processes may vary by country, including differences in procedures, requirements, and timelines.  For country-specific details, please consult your local recruiting / HR team.