Claims Manager
JOB SUMMARY:
Responsible for handling assigned claims from initial assignment to closure, as well as provide assistance in various administrative functions associated with the Excess WC LOB.
ESSENTIAL FUNCTIONS:
At Safety National, we live by the following five core values: Relationships, Integrity, Teamwork, Balance, and Stability. Our Core Values serve as the fundamental foundation of our corporate culture and drive our interactions, both internally and externally. An essential function of all Safety National positions is to fully embrace and represent these core values in our daily work life and relationships.
Determine coverage and evaluate exposure to company.
Establishment and updating of reserves based on department procedures.
Directly or indirectly negotiating claim settlements within established authority level with direct reporting to AVP on settlements over authority limits.
Direct or indirect involvement in the medical management of claims.
Coordinate litigation efforts on claims to include selection of counsel and monitoring of counsel performance in accordance with department litigation guidelines.
Directing and advising TPA as to desired claim handling. Communicate with TPAs to obtain necessary claim details.
Processing of reimbursement requests, and vendor check requests in accordance with department procedures and authority level.
Documentation of claim files as required by department procedures.
Identify claims with reinsurance and provide initial and subsequent updates according to department procedures.
Communication with Underwriters regarding problem accounts, large losses and specific TPA problems.
Travel on an “as needed” basis for TPA and LPT audits including request for audits by underwriting and problem claims with completion of report per department procedures.
ADDITIONAL RESPONSIBILITIES:
Special projects and assistance as may be required
Utilize Medical Management staff and vendor partners to mitigate medical exposure.
QUALIFICATIONS:
Candidate must be a motivated, self-starter with the ability to work independently.
Must have strong organizational and analytical skills, as well as excellent written and oral communication skills.
Must be proficient with Excel, Word and Microsoft Outlook applications.
Minimum five years of experience in Workers’ Compensation claims adjusting with insurance carrier or Third Party Administrator required.
Experience adjusting WC claims in multiple jurisdictions a plus.
Bachelor’s Degree from accredited college or university required.
NOTE:
In order to meet the needs of the Corporation, employees may be assigned other duties in addition to or in lieu of those described above.