Job Description

Job Overview:Primary Purpose:- To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

Essential Functions And Responsibilities:

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determinethe exposure on the claim manages

claims through well-developed actionplans to

an appropriate and timely resolution.

• Negotiatessettlement of claims

within designated authority.

• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due approves and makes timely claim payments andadjustments;

and settlesclams within

designated authority level.

• Prepares necessary statefillings

within statutory limits.

• Manages the litigationprocess ensures

timely and cost effective claims resolution.

• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships toreduce

overall cost of claims for our clients.

• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Reports claims to the excesscarrier

responds to requestsof directions in a professional and

timely manner.

• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented andclaims

coding is correct.

• Refers cases as appropriate to supervisor and management.

​Education & Licensing:

• Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

​Experience:

• ​Five (5) years of claims management experience or equivalent combination of education and experience required.