Workers Compensation Claims Specialist II
About the position The Workers Compensation Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claim's management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. There may be a hybrid work expectations (2 days in office per month) depending on location and nearest office. Training is a critical component to your success and that success starts with reliable attendance. Attendance and active engagement during training is mandatory. Training will require travel for 1 week to our office in Plano, TX in April. Responsibilities Manages an inventory of claims to evaluate compensability/liability. , Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. , Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. , Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. , Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. , Performs other duties as assigned. Requirements BS/BA degree or equivalent work experience. , Minimum of 1-2 years experience in claims adjustment, general insurance or formal claims training. , Required to obtain and maintain all applicable licenses. , Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU). , Knowledge of claims investigation techniques, medical terminology and legal aspects of claims preferred. , Ability to travel for 1 week during training to our Plano, TX office. Nice-to-haves
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