Insurance Claims Specialist

Overview:

Under the direction of the assigned Manager, this Claims Specialist performs a variety of specialized and analytical duties involved in managing claims. This role is responsible for monitoring, coordinating, and processing Workers Compensation, Automobile and General
Liability claims; this includes maintaining case history documentation, contacting, and interviewing involved parties, and serving as a technical resource to employees.

This Claims Specialist is responsible for ensuring timely processing of claims; evaluating accident reports to determine accuracy and completeness and ensuring adequate investigation.
This position is also responsible for ensuring that the Company is in compliance with applicable laws and regulations and providing training and guidance, as needed.

• Monitor and record appropriate leave usage relative to Workers Compensation benefits; notify payroll and other appropriate personnel regarding adjustments
• Provide technical guidance and advice to supervisors, managers and site representatives regarding Workers Compensation, Auto Accidents and General Liability issues; serve as liaison between return-to-work program, injured employees, and managers in relation to returning injured employees back to work, repair shop, and Fleet department for auto repairs, and provide documentation as necessary to adjusters and defense counsel in lawsuits
• Analyze circumstances of claims, injury records, medical evaluations, accident videos and photos, and document injuries; assure prompt delivery of medical and financial services and the return of injured workers to safe and productive employment in a timely manner along with timely repair of company vehicles
• Assist Risk Manager with facilitating and coordinating program-related training as appropriate; assist in providing training to departmental administrative personnel regarding roles in recording/reporting job-related injuries, damage to company vehicles, and liability coverage
• Prepare and maintain a variety of records, logs, correspondence, and files related to assigned activities; maintain OSHA records
• Receive, file, and organize employee accident reports; determine reportable accidents; initiate and process claims; maintain files and correspondence regarding employee accident reports; maintain communication with third party administrators; notify managers regarding employee accident reports, trends or preventative measures
• Coordinate and maintain schedules for ergonomic evaluations for employees with the ergonomic evaluator; assist the evaluator as requested; maintain related spreadsheets; submit and track work orders placed to the appropriate department for the installation of employee’s ergonomic supplies.
• Receive and process information on property and liability claims; provide requesting parties appropriate documentation and forms regarding property and liability claims
• Receive billings; obtain appropriate signatures and submit to accounts payable for payment
• Other related duties, as assigned
• Excellent organization and time management skills to handle multiple tasks in an environment with large volumes of data and paperwork
• Excellent verbal and written communication skills
• Excellent customer service skills, both orally and in writing
• High degree of accuracy and exceptional attention to detail
• Proven time management skills with a proven ability to meet deadlines
• Ability to interpret, apply and explain Workers Compensation coverage and benefits to employees
• Ability to maintain confidentiality with sensitive data
• Ability to function well in a fast-paced and demanding environment
• Ability to establish and maintain comprehensive records and prepare reports
• Ability to interpret, apply and explain applicable laws, codes, rules and regulations
• Ability to analyze facts, information, and data
• Ability to establish and maintain cooperative and effective working relationships with others
• Ability to appropriately prioritize tasks and to meet schedules and timelines (time management)
• Ability to execute tasks independently

• High school diploma or equivalent required, college degree preferred
• Prior onboarding Workers’ Compensation required
• Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
• HVAC Industry experience or service industry a plus
• Continuously able to work in office environment
• Continuously able to operate a computer and other office productivity machinery, such as a copy machine, telephone, and computer printer
• Continuously able to sit at a computer for up to 8 hours
• Able to alternate between sitting and standing, as needed throughout the day
• Occasionally able to lift up to 15 lbs
• Continuously requires vision, hearing, twisting, and talking
• Occasionally requires walking, lifting, carrying, reaching, kneeling, pushing/pulling, bending, and crouching
• Rarely requires climbing