AddressCompany Overview: This large corporation is made up of specialty writers of professional liability, products liability, and workers' compensation insurance. With approximately 1,000 team members operating in all 50 states, they are well-positioned to offer career opportunities to individuals interested in professional growth.
Job Overview: This company is seeking a Senior Claims Representative with at least 5 years of experience in workers' compensation claims management to support their workers' compensation line of business. It is fully remote and based in Massachusetts. Candidates should have experience and knowledge handling claims in Massachusetts, along with other New England States. The primary responsibility of this position is to consistently execute the Company's Return to Wellness philosophy and business model that leads to better outcomes for their injured workers and insureds. Responsibilities of this position include managing all aspects of assigned claims, including verifying coverage, investigating, managing, and resolving complex workers' compensation claims for the Company's large customers under moderate supervision, following established Company requirements and procedures, and promptly establishing and maintaining accurate reserves with an authority limit of up to $75,000, all in support of the Company's revenue and profitability objectives and overall business plan.
Job Responsibilities:
Essential Functions:
Complete ongoing claim management activities proactively and with a sense of urgency in accordance with their Return to Wellness philosophy in order to execute the established plan of action and achieve favorable outcomes for all parties. Maintain, cultivate, and develop high quality, collaborative working relationships with all parties, including injured workers, agents, customers, and co-workers. Maintain regular contact by telephone and correspondence with all parties. Seek complete information necessary to manage claims and achieve favorable outcomes. Respond to inquiries in a timely, courteous, and professional manner. (35%),Promptly investigate all assigned claims in order to establish trust and rapport with all parties, accurately assess coverage, determine the nature and extent of the injuries sustained, and reinforce Return to Wellness expectations. Make fair and timely determinations of compensability. Demonstrate empathy, professionalism, integrity, and objectivity at all times. Prepare reports and forms as required by jurisdictional regulations and by the Company's established procedures. Promptly establish and maintain case reserves that accurately reflect the anticipated financial exposure on each claim; revise reserves promptly based on changes in facts and circumstances. Identify subrogation potential. (25%)Prepare claim status reports for customers, agents, underwriters, reinsurers, and others as needed; attend point of sale presentations; attend claim review meetings with customers as necessary to serve claims and present reports. (15%)Manage Return to Wellness initiatives by working collaboratively with agents, clients, risk managers and underwriters to ensure proper return to work guidelines and procedures are established, followed, and achieved. (15%)Secondary Functions:
Prepare for and attend monthly large account team meetings; participate in discussions regarding results, profitability, and renewal strategy. (5%)Assist with company projects as assigned and continue professional growth and development through the attendance and participation in insurance related events/functions, seminars, classes, and conferences. (5%)Requirements:
Bachelor's degree and a minimum of 5 years of experience in workers' compensation claims management or a minimum of 10 years working in a professional claims capacity in worker's compensation without a degree is required; advanced certification or training is preferred.Comprehensive knowledge of applicable state laws and industry standards.Ability to independently attend insurance and industry/business functions to promote and present a positive image of the Company.Proficiency in Microsoft Office computer applications; ability to learn new computer software applications.Advanced analytical ability in order to analyze and interpret information and make appropriate decisions regarding claims payments.Excellent organization, time management, and negotiation skills.Attention to detail in processing all information, establishing priorities and meeting deadlines.Excellent analytical and problem-solving skills, including formulating logical and objective conclusions.Ability to assess the urgency and importance of a situation and take appropriate action.Empathic listener with the ability to listen and respond to another person in a way that engenders mutual understanding and trust.Ability to communicate effectively and professionally both verbally and in writing with various constituencies and at all levels, both in and outside of the organization, including agency partners, customers, injured workers, and providers.Compensation/Benefits:
The approximate annual base salary range for this position is $61,000 to $102,000. The salary range represents the entirety of the pay grade for this position. Most candidates will start in the bottom half of the range. Factors that may be used to determine your actual salary include your specific skills, how many years of experience you have, your location and comparison to other team members already in this role.This company offers a comprehensive medical package, PTO, and company holidays.