Claim Representative I

Proassurance Corporation Wexford , PA 15090

Posted 2 weeks ago

An exciting opportunity exists to join the ProAssurance family of companies!

We are a specialty writer of professional liability, products liability and workers' compensation insurance. With over 1,000 employees operating in 40 states, our company is well positioned to offer career opportunities to individuals interested in professional growth.

The primary responsibilities of this position include verifying coverage, investigating, managing and resolving claims for the Company's clients under moderate supervision, following established Company and client requirements and procedures, and promptly establishing and maintaining accurate reserves up to an authority level all in support of the Company's revenue and profitability objectives and overall business plan.

Essential Functions:

  • Maintain contact by telephone and/or correspondence, with all necessary parties in order to achieve the established plan of action in a timely manner

  • Investigate all losses promptly as assigned in order to accurately assess coverage, nature and extent of injury/damages sustained, identify subrogation potential and prepare proper reports and forms as required

  • Establish and document a proactive strategy to achieve timely resolution of claims, within statutory requirements and Company guidelines

  • Maintain appropriate case reserves for each assigned claim in accordance with the Company's reserving philosophy and/ or the customer's reserve guidelines; Review, approve for payment, or deny medical invoices within timeframe set by statutory requirements

  • Manage return-to-work 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.

Qualifications

  • A Bachelor's degree and a minimum of one year experience or a minimum of three years experience working in a professional claims capacity in worker's compensation is required; advanced certification and training is preferred.

  • Working knowledge of applicable state laws and industry standards

  • Ability to 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 profitable decisions regarding claims payments

  • Excellent organization and time management skills

  • Strong negotiation skills

  • Attention to detail in processing all information, establishing priorities and meeting deadlines

  • Strong 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

  • 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, outside customers and clients

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Claim Representative I

Proassurance Corporation