Senior Claims Specialist

Essential Duties and Responsibilities include, but are not limited to the following:

• Assists in the day-to-day processing of Workers' Compensation, Automobile Claims and General Liability claims, including obtaining, checking, recording, and evaluating employee as well as third party information related to these claims. Trains other Claims Specialist on a uniform processing and tracking these claims.

• Evaluates information and reports relative to claims payments.

• Evaluates and processes claim handling invoices from our adjusters and/or insurers.

• Addresses questions about Workers' Compensation programs, informs employees of their rights and benefits under various state workers' compensation laws.

• Compiles and analyzes claims data and makes recommendations for policy, procedural, legal, and rule changes.

• Compiles and reports claims data to various internal databases and personnel.

• Gathers information/data on accident causes and reports on hazardous or dangerous conditions/actions on company property/worksites and coordinates with Safety and/or the Company's insurance providers.

• As it relates to Workers' Compensation claims, assists in maintaining on-going oversight of third-party providers that includes, but is not limited to, requesting investigation activities to verify suspicious claims, questioning and resolving discrepancies, monitoring of medical treatment, including rehabilitation, and reviewing case reserves for adequacy.

• Works with the claims adjuster and/or defense counsel in the identifying and interviewing witnesses. Works with the claims adjuster and/or defense counsel in the gathering and production of documents, and other information related to the claims.

• May confer with and assist with insurance carrier defense attorneys and adjusters, and may attend settlement conferences, trials, and hearings.

• Provides general assistance and works with internal and external counsel in the defense of a claim.

• Provides courteous and expeditious customer service to administrators, employees, and the general public.

• Reviews and evaluates settlement authority requests and makes recommendations for approval or revision.

• Acts as a Liaison to the Company's Return to Work program, as required.

• May assist in restitution/subrogation activities.

• May review medical bills, disability benefits, and payroll records to ensure compliance and accuracy of information provided to third parties.

• Performs related duties as assigned.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

General Knowledge of -

• Various state labor code provisions pertaining to workers' compensation rules, regulations, and appeals.

• Standard claims evaluation techniques, references, and settlements

• Medical and legal terminology related to workers' compensation claims processing

Ability to -

• Analyze, interpret, and apply laws, rules, and regulations pertaining to workers' compensation, occupational health and safety, automobile insurance and general liability insurance.

• Analyze individual claims and use judgment and diplomacy in recommending or exercising appropriate action.

• Write clear, comprehensive, and accurate reports and correspondences

• Interpret statistics and make accurate arithmetical computations

• Work effectively with corporate, Operating Unit, insurance carrier personnel and the public

• Effectively communicate orally and in writing.

Education -

• Two years of college, preferably supplemented by courses in workers' compensation, general business, insurance, or state issued workers' compensation certifications.

Experience -

Two to three years of experience as a workers' compensation claims processor/adjuster, which must include at least one year of experience regarding state workers' compensation claims covered by any one or more of the following state laws: Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, Texas, or Utah. California experience is helpful but not mandatory.

Or

Two years of experience performing duties that required interpretation, explanation, and application of rules and regulations applicable to workers' compensation, which must include at least one year of experience regarding workers' compensation claims. California experience is helpful but not mandatory.

Great Benefits

• Medical and prescription drug plans

• Dental and Vision insurance benefits

• Life/AD&D insurance benefits

• Health Care and Dependent Care Flex Spending accounts

• Health Savings Account

• Disability income protection

• Paid time off (vacation and holidays)

• 401(k) retirement savings plan

• Relocation assistance available

We are an equal opportunity employer: We do not discriminate based on race, color, national origin, religion, creed, sex, sexual orientation, gender identity, disability, age, genetic information, marital status, military status, membership or activity in a local human rights commission, or status with regard to public assistance, or any other characteristic protected by applicable law.