Review, evaluate, negotiate and processes WC Claims of moderate/severe/catastrophic complexity, provide recommendations and strategies for resolution, and litigation management as appropriate. Collaborate with internal and external clients, and often interact with agents, claimants, and policyholders.
Responsibilities
- Analyze and process workers’ compensation claims by investigating and gathering information to determine compensability and exposure on claims, handling multiple jurisdictions.
- Calculate and assign timely and appropriate reserves on claims and monitor reserve adequacy throughout the life of the claim.
- Develop and manage claims updating action plans as the claim progresses and bring the claim to an appropriate and timely resolution.
- Accurately calculate and timely pay benefits due pertaining to the jurisdictional guidelines.
- Operate within designated authority level and time constraints pertaining to payments and settlements.
- File appropriate forms per jurisdictional protocol, within statutory limits.
- Actively manage and guide the litigation process, ensuring timely and cost-effective claims resolution.
- Participate in claim reviews, which may require limited travel, and timely production of claim reports.
- Coordinate vendor referrals for additional investigation and/or litigation management.
- Use appropriate cost containment techniques including strategic vendor partnerships to mitigate overall cost of claims.
- Manage claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
- Frequently collaborate with all appropriate parties involved with the claim, and clearly document that collaboration.
- Maintain professional internal and external client relationships.
- Actively execute timely and appropriate claims activities to ensure consistent delivery of quality claims services.
- Proactively manage all litigated claims by clearly documenting the litigation plan and budget, retaining competent counsel, communicating with counsel on a regular basis and clearly documenting the litigation action plan and strategy.