Claims Specialist II
LoanCare
Complex Claims Specialist – Workers' Compensation
biBerk Business Insurance
full-time
Posted on:
Location Type: Remote
Location: Remote • Alabama, Arizona, California, Colorado, Connecticut, District of Columbia, Florida, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming • 🇺🇸 United States
Visit company websiteSalary
💰 $100,000 - $125,000 per year
Job Level
SeniorLead
About the role
- Investigate coverage, determine compensability, and manage a pending of high exposure Workers’ Compensation claims involving catastrophic injuries and complex cases
- Proactively establish and update reserves throughout the life of the claim to reflect claim exposure and document supporting rationale
- Resolve claims within authority and make independent case value recommendations to senior leadership on cases which exceed authority
- Participate in reserving, pricing and strategy discussions with senior leadership
- Collaborate with outside defense counsel to effectively manage litigated files according to established litigation management guidelines
- Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills
- Ensure compliance with state and federal Workers’ Compensation regulations
- Provide exceptional customer service to policyholders, agents, injured workers, medical providers, legal, and vendors
- Follow escalation and reporting requirements on claims with significant exposure
- Develop creative resolution strategies to manage losses involving complex issues, effectively utilizing appropriate internal and external resources
- Document claim files in accordance with company and regulatory guidelines
- Identify subrogation potential and red flags that require SIU involvement
- Train new team members
- Act as a technical resource to less experienced claims representatives
Requirements
- Active adjuster license required
- bilingual candidates strongly preferred (Spanish/English)
- 10+ years of experience handling complex workers’ compensation claims
- Excellent organizational, leadership, communication and time management skills
- Experience with structured settlements and Medicare Set-Asides
- Ability to work in a fast-paced, collaborative, virtual office environment
- Strong analytical, organizational, and time management skills
- Excellent written and verbal communication skills
- Ability to work independently and meet assigned deadlines
- Strong negotiation skills
- Ability to multi-task and effectively prioritize tasks with frequent interruptions
- Proficiency with MS Word, Excel and internet applications
- Highly attentive to details
- Able to work under pressure and execute good judgment in sensitive situations
- Advanced verbal and written communication skills are essential for interacting with internal and external stakeholders
Benefits
- Great work environment with growth opportunity
- Subsidized downtown parking (for in-office positions)
- Competitive compensation
- Generous amounts of vacation and sick time
- Closed on major holidays
- 401(k) with company match
- A fantastic healthcare package
- Tuition reimbursement after 6 months of employment
- Service recognition after 5 years of employment
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
Workers’ Compensation claimsstructured settlementsMedicare Set-Asidesclaims managementsubrogationlitigation managementreservingpricing strategycase value recommendationsloss management
Soft skills
organizational skillsleadership skillscommunication skillstime management skillsanalytical skillsnegotiation skillsattention to detailindependent workmulti-taskingcustomer service
Certifications
active adjuster license
