Claims Representative
- Employer
- A.I.M. Mutual Insurance Companies
- Location
- Burlington, Massachusetts
- Salary
- Open
- Posted
- Apr 13, 2017
- Closes
- Jun 12, 2017
- Category
- Claims, Workers' Compensation
- Job Type
- Full Time
- Career Level
- Not Specified
Job Function: Ensure the equitable and justified investigation, evaluation and settlement/closure of workers compensation claims in accordance with A.I.M. Mutual Insurance Company’s specified service standards, industry requirements and audit procedures.
Essential Functions:
- Investigate Claims: Evaluate coverage, liability, disability and causal relationship issues as well as potential loss value immediately upon receipt of first report. Investigation practices include direct observation, interviews with concerned parties, reports from policyholders and claimants, and use of consumer reporting agencies. Manage investigation through final disposition in a timely manner with proper diary and reporting documentation throughout.
- Evaluate Claims: Evaluate liability, disability and causal relationship based on detailed investigation consistent with industry guidelines, state laws and A.I.M. Mutual’s unique service requirements. Timeliness and thoroughness are key. Begin negotiation process within established authority limits or consult supervisor depending on complexity of case. Work with the employer/policyholder to assess return to work potential. Make recommendations on proper case reserving within established authority guidelines.
- Negotiate Claims: Actively engage in negotiation proceeding with claimants and/or policyholders as assigned. Recommend proper course of action to follow (within authorized reserve authority) to achieve fair settlement.
- Settle/Dispose Claims: Within authority, provide prompt payment of workers compensation benefits as warranted. Arrange, ensure and monitor initial and ongoing medical care to injured claimants by utilizing rehabilitation measures to return the injured to gainful employment, including modified duty, in the shortest period of time.
- Litigation Coordination. Represent company in settlement of meritorious claims and suits expediently and economically; contest claims and defend suits that are without merit. Liaison with vendors. Work with defense counsel on legal handling and litigation management.
Additional Responsibilities
- Ensure complete and accurate documentation on mandated state and company forms and filings.
- Perform on-site service visits as requested or as needed.
- Contribute to the establishment of proper case reserves on each claim with supporting documentation.
- Ensure accessibility to policyholders at all times.
Qualifications:
- Minimum three to five years of claim technical experience, with emphasis on workers compensation. College degree preferred.
- Exceptional written and oral communication skills.
- Ability to organize and prioritize work flows and meet company/industry deadlines.
- Self-motivated, able to work with little direction.
- Industry training and professional designation a plus.