The Claims Professional is responsible for the analysis and management of workers’ compensation claims for assigned clients, including minor and complex claims.  This position will review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims.  The position will process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. Acts in a fiduciary role on behalf of policyholders and negotiates claim settlements. Claims Professionals conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and state statutes. Experience and the degree to which a claim professional can work independently to make sound decisions, reserve recommendations and drive outcomes will determine the hiring position, ranging from a Claim Representative I to a Senior Claim Representative. The Claims Professional is expected to function with a high degree of competency and independence. The use of sound judgment coupled with strong technical claim handling skills and consistent results are expected.    Principle Responsibilities - Analyzes and processes workers’ compensation claims by investigating and gathering information to determine the exposure on the claim. - Negotiate settlement of claims up to designated authority level and makes claims payments. - Calculates and assigns timely appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim. - Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level. - Develops and manages claims though well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution. - Prepares necessary state filings within statutory limits. - Actively manages the litigation process; 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 to reduce overall cost of claims. - Frequently communicates with all appropriate parties involved with the claim. - Maintains professional client relationships. - Actively executes appropriate claims activities to ensure consistent delivery of quality claims services.

Key Risk is looking for a claims professional who enjoys analysis and management of workers compensation claims.    Principle Responsibilities - Analyzes and processes workers’ compensation claims by investigating and gathering information to determine the exposure on the claim. - Negotiate settlement of claims up to designated authority level and makes claims payments. - Calculates and assigns timely an appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim. - Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level. - Develops and manages claims though well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution. - Prepares necessary state filings within statutory limits. - Actively manages the litigation process; 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 to reduce overall cost of claims. - Frequently communicates with all appropriate parties involved with the claim. - Maintains professional client relationships. - Actively executes appropriate claims activities to ensure consistent delivery of quality claims services.

Key Risk is looking for an enthusiastic professional who will be responsible for the management of medical only workers’ compensation claims.   Principle Responsibilities - Maintain good lines of communication with employers, adjusters, and providers - Discuss with an employer, issues relative to an injured workers’ return to work status - Request medical notes, proper billing format, and other written/verbal information from employers and medical providers to determine appropriateness of payment of medical bills and whether a claim is truly medical only - Timely and accurately reserve for medical only claims assigned - Document relevant written and oral communication received relative to medical-only claims in the log notes - Discuss with an employee, issues relative to whether a bill has been paid or whether travel or medical reimbursement has been issued - Assist in the management of communication of the unit with customers, providers and injured employees - Enter medical notes into claim log as required - Index images as needed - Identify potential subrogation claims and notify appropriate supervisor

Key Risk is looking for an enthusiastic individual who wants to learn account management and technical knowledge of workers compensation claims.    Principle Responsibilities - Interface with Underwriting, Risk Management, and clients in controlling costs and loss ratios - Conduct investigation of workers' compensation claims assigned - Handle all technical aspects of claims, including coverage, disability benefit management, medical management, litigation management, file management, subrogation, reserving and settlement - Maintain and demonstrate knowledge of the Workers' Compensation Act and Rules and Regulations in jurisdictions assigned - Immediately notify management of large exposures and comply with reinsurance reporting requirement - Monitor expenses and effectiveness of inside/outside vendors - Assume full responsibility for all phases of account management for accounts as assigned and inform management of any unfavorable trends - Actively work with mentor in monitoring loss ratio for accounts assigned - Participate in client meetings for training on claims issues and assist with claims service meetings for new accounts as requested