Senior Claims Specialist - Workers Compensation

Dublin, Ohio (US)

 

Manage within company standards and best practices complex and problematic high visibility workers' compensation claims within delegated limited authority to determine benefits due, work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer requirements to achieve the best possible outcome in the claim.

Essential Job Duties:

  1. Receives claim, confirms policy coverage & acknowledgement of claim
  2. Determine validity & compensability of claim by investigating & gathering info, file necessary documentation with state agencies
  3. Establish reserves & authorize payments within reserving authority limits
  4. Develop and manage well documented action plan with case manager, attorney, supervisor & client to reduce overall cost of claim
  5. Coordinating early return to work efforts with case manager & employer
  6. Negotiates settlements when necessary
  7. Actively manage the litigation process
  8. Identifies potential subrogation claims
  9. Communicate claim status with customer and claimant
  10. Adhere to client guidelines & participate in claim reviews as needed
  11. Develops & maintains professional customer relationships

Education/Training Requirements:

  1. Degree at an accredited college or university preferred
  2. Three years handling claims WC Lost Time 
  3. Excellent oral, written communication skills & customer service
  4. PC literate, including Microsoft Office (Word, Excel)
  5. Effective analytical & interpretive skills
  6. Strong organizational skills
  7. Great interpersonal skills

Skills: claims, workers compensation, adjuster, Bonus: no Reason Open: growth