DEPARTMENT: CLAIMS
REPORTS TO: UNIT SUPERVISOR
STATUS: EXEMPT
HOURS: Mon - Fri / 9am - 6pm
REQUIREMENTS:
- Bachelor’s degree and/or 2-5 years relevant claims adjusting experience in the
workers’ compensation field is preferred but not required.
- Relevant state licensing where required.
- Computer literacy; familiarity with Microsoft Office a plus.
- This individual will adhere to the code of ethical conduct and is required to
engage in fair claims settlement practice.
JOB SUMMARY:
- Independently adjudicates California or multi-state workers’ compensation
indemnity claim files that are non-catastrophic in nature, claim exposures up to
$100,000 incurred reserves within branch authority, and some catastrophic claim
handling, in accordance with jurisdictional requirements, and Midwest Claims
Practices.
- Conduct timely investigations, including obtaining telephonic/recorded
statements, in person interviews, contact with insured, employee, physician,
attorney, witness.
- Handle and review coverage issues, determine compensability, schedule
appropriate exposure, and address timely benefit delivery.
- Recognition of 3rd party liability, and subrogation handling through recovery.
- Identify and review the need for medical case/vocational management to a
specific loss, and direct/manage activity relative to managed care.
- Interface and manage handling with defense attorneys and investigative vendors
when presence is required. Litigation experience is required, and control to the
extent we can no longer act in the presence of counsel. Direct settlement resolution
with the injured worker and/or with opposing counsel will be expected. Litigation
management from initial Arbitration to the Supreme Court level is required.
Attendance may be required at hearings, on cases of larger exposure, and/or when
testimony is required. Client visits will be required depending on special handling
parameters as defined in our best practices, account special handling instructions,
or at the discretion of the Unit Manager. Status report completion is required on
claims greater than or equal to $50,000.
SKILL AND ABILITY PROFILE:
- Good listening; and good written and communication skills
- Ability to work independently and stronghold the understanding of human nature
and motivation principles.
- Readily control/handle problem issues in times of stress, and/or in a climate of
conflict or adversity.
- Ability to document claim file activities is required.
- Responsiveness to changing business or customer needs.
If interested, please e-mail resume and cover letter to:
