Claims Representative

Job Description :

Investigates, evaluates and proactively manages claims of varying complexity through final disposition. Addresses coverage and compensability issues. Handles lost time claims, including include high IWIS claims, high-exposure claims and claims for special accounts. Responsibilities also include medical case management, litigation management, return-to-work strategies and settlement where necessary. Serves as a resource and mentor to department members. Utilizes technology and systems for claims management, including document management, utilization review and pharmacy management. Claims are managed independently under general direction, following established policies, procedures and precedents.

Responsibilities :

• Serve as the dedicated claims representative for assigned accounts, ensuring customer service requirements are met.
• Proactively manage litigated claims with in-house legal or outside counsel, focusing ontimely resolution and / or settlement.
• Evaluate and settle all claims with settlement potential within increased authority limits; present claims exceedingauthority limits to executive claims committee for resolution of large exposure claims.
• Investigate and determinecoverage, compensability, subrogation and second injury fund potential,resolving complexcoverage issuesinvolvingmultiple carriers or employerliability exposure.
• Manage occupational disease claims and other complex claims, including high IWIS and high-exposure claims.
• Effectively manage personal caseload to mitigate exposure whilecontrollingclaim costs.
• Develop cost containment strategies for large claims and recommend solutionsfor productive case outcomes.
• Document claim files in compliancewith quality review standards and complete reinsurance reporting on high exposure claims.
• Investigate larger, more complex workers' compensation claims using sound-claims handling techniques in alignment with company claim philosophy and quality assurance standards.
• Establish and maintain appropriate reserves, accurately reflecting file exposure in accordance with company reserving procedures.

Requirements :

Contact : Alexandria Van Riper

avanriper@jacobsononline.com