AZ - WC Claims Specialist (On-Site)

About Us

Founded in 2004, Vensure Employer Services provides PEO solutions and human resource outsourcing to small and mid-market businesses across the country. Through its subsidiaries, including VensureHR, the company processes more than $19 Billion in payroll and supporting more than 874,770 worksite employees. With services including payroll, medical and voluntary benefits, workers' compensation, risk management and HR administration, Vensure companies support a broad spectrum of industries, allowing small business owners to cost-effectively manage HR functions and turn their attention to growth and profitability initiatives.

Position Summary

Workers' Compensation Claims Specialist will service our Executive-level clients worker's compensation claims with minimal supervision. This role requires that the Specialist monitor their assigned employers' workers' compensation claims, from inception thru closure, to ensure that all salient aspects of claim adjudication are being effectively and efficiently performed.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

• Responsible for servicing our Executive-level clients worker's compensation claims. Service includes shadow adjusting and acting as a liaison between the injured worker, client and TPA responsible for adjudicating workers' compensation losses. This involves ongoing detailed claims analysis, accident and subrogation investigation identifying red flags and potential fraud.
• Additional responsibilities include ensuring accurate reserving practices, facilitating light duty, oversight and facilitation of both medical and legal management.
• Ability to evaluate settlement value and coverage issues with the assistance of a Sr. Claims Specialist or Supervisor.
• Mitigating claim severity and driving positive claim outcomes by leading our TPA towards claim resolution.
• Preparing and presenting strategic claim reviews with client and/or carrier.

Knowledge, Skill and Abilities

• Team player with exceptional customer service skills.
• High work standards, results orientation and self-motivated.
• Strong complaints handling, dispute resolution and ability to manage difficult situations.
• Ability to meet deadlines and ensure all tasks are completed within service guidelines.
• Ability to make sound decisions with confidence.
• Strong analytical skills with an eye for detail.
• Ability to effectively coach and assist Claims Specialists and Claims Associates.

Education & Experience

• High school/GED, some college preferred.
• 2-3 years of insurance or claims work experience required.