workers compensation claims specialist

CorVel Corporation

<div><p>We are seeking a 4850 Sr. Claims Specialist for our Southern California Team. The Sr. Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel.</p>
<p>
We are open to remote work. Candidates must reside in California.</p><br>
<p></p>
<p><b>
ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:
</b></p><ul><li>Receives claim, confirms policy coverage and acknowledgement of the claim</li>
<li>Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies</li>
<li>Establishes reserves and authorizes payments within reserving authority limits</li>
<li>Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim</li>
<li>Coordinates early return-to-work efforts with the appropriate parties</li>
<li>Manages subrogation and litigation of claim as it applies</li>
<li>Manages potential claim recoveries of all types</li>
<li>Reports claims to the excess carrier when applicable</li>
<li>Communicates claim status with the customer and claimant</li>
<li>Adheres to client and carrier guidelines and participates in claims review as needed</li>
<li>Develops and maintains professional customer relationships</li>
<li>Complies with rules and regulations of applicable state</li>
<li>Additional projects and duties as assigned</li></ul><br>
<p></p>
<p><b>
KNOWLEDGE &amp; SKILLS:
</b></p><ul><li>Excellent written and verbal communication skills</li>
<li>Ability to assist team members to develop knowledge and understanding of claims practice</li>
<li>Ability to identify, analyze and solve problems</li>
<li>Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets</li>
<li>Strong interpersonal, time management and organizational skills</li>
<li>Ability to work both independently and within a team environment</li>
<li>Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers&rsquo; Compensation</li></ul><br>
<p></p>
<p><b>
EDUCATION &amp; EXPERIENCE:
</b></p><ul><li>Bachelor's degree or a combination of education and related experience</li>
<li>4-5 years of California Workers&rsquo; Compensation claims handling experience required</li>
<li>CA workers compensation adjuster license required</li>
<li>Associates in Claims or Associates in Risk Management designation preferred</li>
<li>4850 experience required</li></ul><br>
<p></p>
<p><b>
PAY RANGE:</b></p>
<p>
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.</p>
<p>
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.</p>
<p>
Pay Range: $29.35 - $47.28 per hour</p>
<p>
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management</p>
<p>
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.</p><br>
<p></p>
<p><b>
About CorVel
</b></p><p>CorVel, a certified Great Place to Work&reg; Company, is a national provider of industry-leading risk management solutions for the workers&rsquo; compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).</p>
<p>
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.</p>
<p><b>
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.</b></p>
<p>
#LI-Remote</p></div>

CA WC Senior Claims Specialist (SIP) 4850

Zurich Insurance

<div><div>Zurich is looking for an accomplished Workers Compensation Sr. Claims Specialist for or our Northeast region. This position offers a hybrid work schedule from our Parsippany or Boston offices, or a fully remote setup based in one of the following states: Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, or West Virginia.</div><div></div><div><br>
The Senior Workers Compensation Claims Specialist will handle multi-party commercial line Workman&rsquo;s Compensation claims of moderate to high exposure and complexity within specific authority limits, to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.</div><div></div><div><br>
In this role you will be responsible for:</div><br>
<div></div><ul><li>
Document claims file by accurately capturing and updating claims data/information in compliance with best practices for single and multi-party personal or commercial line claims of moderate to high exposure and complexity.</li><li>
Exercise judgment to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.</li><li>
Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.</li><li>
Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.</li><li>
Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.</li><li>
Assess damages by calculating applicable damages or range of damages allowed by law.</li><li>
Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.</li><li>
Meet quality standards by following best practices</li></ul><p></p><p><br>
Basic Qualifications:</p><br>
<p></p><ul><li>
Bachelor&rsquo;s Degree and 6 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
Zurich Certified Insurance Apprentice, including an Associate Degree with 6 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area.<br>
OR</li><li>
High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area.<br>
AND</li><li>
Must obtain and maintain required adjuster license(s)</li><li>
Microsoft Office experience</li><li>
Knowledge of insurance regulations, markets and products</li></ul><p></p><p><br>
Preferred Qualifications:</p><br>
<p></p><ul><li>
6+ years of experience in the Workers Compensation line of business</li><li>
6+ years of experience handling litigation management
</li><li>Specializing in the jurisdictions of NY and NJ</li><li>
Learn and handle additional jurisdictions as needed
</li><li>EDI filing requirements</li><li>
MSA/Medicare knowledge
</li><li>WCCA, WCCP Designations</li><li>
Knowledge and skill of claims handling</li><li>
Negotiation experience</li><li>
Experience in line of business</li><li>
Excellent communication skills</li><li>
Analytical skills</li></ul><p></p><p><br>
Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply&mdash;your unique background matters to us. The pay range shown is a national average and may vary by location. The proposed Salary range for this position is $75,800.00 - $124,100.00, with short-term incentive bonus eligibility set at 15%.</p><p></p><p><br>
We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.]</p><p></p><p><b><br>
Why Zurich?</b></p><p>
At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment&mdash;so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500&reg;.</p><p></p><p><br>
Join us for a brighter future&mdash;for yourself and our customers.</p><p></p><p><br>
Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets.</p><p></p><p><br>
Zurich complies with 18 U.S. Code &sect; 1033.</p><p></p><p><b><br>
Please note:</b> Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal.</p><p>
Location(s): AM - Parsippany, AM - Boston, AM - Connecticut Virtual Office, AM - Delaware Virtual Office, AM - Maine Virtual Office, AM - Massachusetts Virt. Office, AM - New Hampshire Virt. Office, AM - New Jersey Virtual Office, AM - New York Virtual Office, AM - Pennsylvania Virtual Office, AM - Rhode Island Virtual Office, AM - Virginia Virtual Office, AM - West Virginia Virt. Office<br>
Remote Working: Hybrid<br>
Schedule: Full Time<br>
Employment Sponsorship Offered: No<br>
<br>
Linkedin Recruiter Tag: #LI-MD1 #LI-ASSOCIATE #LI-HYBRID</p></div>

Sr. Claims Specialist, Workers Compensation (NE Region)

NJM Insurance Group

<div><div>The overall responsibility of this position is to consistently execute on the Company&rsquo;s mission, vision, and values, leading customer service approach, and claims business model to provide best outcomes on complex/high severity claims. The Complex Claims Specialist, Senior will be responsible for contacting all parties involved in the claim, gathering, and securing all necessary information to effectively evaluate the claim, and implement an action plan to manage the claim.</div><div></div><div>
The Complex Claims Specialist, Sr will work with and communicate to NJM policyholders, injured workers, medical providers, the NJM Medical Services Administration Department, Special Investigation Unit, WC Legal Staff, other departments within NJM, and vendors as needed. This is a senior level position in the Complex Claims track that will require minimal supervision and guidance to accomplish the goals and objectives of the role.</div><div></div><div>
Essential Duties and Responsibilities:</div><ul><li><div>
Review, investigate, and analyze the loss event, the injury, and relevant information on all assigned claims to make a compensability decision and plan a course of action. Initiate and provide excellent communication with all stakeholders during the course of the claim.</div></li><li><div>
Send all appropriate documentation, including but not limited to, medical release form and wage statement at the onset of the claim process. Assist as needed in setting reserves.</div></li><li><div>
Manage all assigned high severity claims, including aged claims and catastrophic (CAT) losses that generate significant medical costs each year.</div></li><li><div>
Authorize quality, cost effective medical care within state statutory, regulatory, and legal guidelines, while seeking MMI threshold to mitigate future exposures.</div></li><li><div>
Early coordination with other NJM resources, including but not limited to: WC Medical Services Administration, WC Sales, WC Underwriting, WC SIU, WC Legal to provide a collective and strategic action plan.</div></li><li><div>
Authorize and issue indemnity payments and evaluate the appropriateness of making a voluntary offer of partial permanent disability. Document all actions taken throughout the course of the claim, adhering to each department's guidelines.</div></li><li><div>
Ensure proper data integrity to support the reporting of accurate claim data to internal and external entities.</div></li><li><div>
Effectively manage claims, build rapport and educate the policyholder, including large, assigned accounts on NJM procedures, policies and claim practices to achieve customer retention that drives to NJM goals of profit and growth.</div></li><li><div>
Frequently mentor and assist in training for developmental purposes of staff.</div></li><li><div>
Partners with the Supervisor, Sales, MCS or others in preparing for and conducting successful meetings with clients and brokers demonstrating the NJM value proposition. Handles all interactions with stakeholders (injured workers, providers, attorneys, brokers, clients) professionally and proactively with customer-centric approach.</div></li><li><div>
Will prepare for, attend, participate with the Supervisor at Claim Reviews with customers and brokers.</div></li></ul><div></div><div>
Required Qualifications:</div><ul><li><div>
5-8 years&rsquo; work experience as a Workers' Comp Claim Representative, or comparable insurance knowledge and experience with various aspects of Workers' Comp claims handling and process</div></li><li><div>
Must demonstrate sound knowledge of medical terminology and applicable case law</div></li><li><div>
Customer service oriented with strong written and oral communication skills with ability to work both in a team setting and independently</div></li><li><div>
Demonstrated organizational skills aimed at bringing files to timely resolution and best outcome</div></li><li><div>
Critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details</div></li><li><div>
Working knowledge utilizing an automated claim processing system and the Microsoft Office suite of tools (Word, Excel)</div></li><li><div>
Ability to travel for business purposes, approximately less than 10%</div></li><li><div>
High school diploma or GED equivalent</div></li></ul><div></div><div>
Preferred Qualifications:</div><ul><li><div>
Multi-state experience and/or licensing (including NJ, MD, CT, DE, PA and/or NY)</div></li><li><div>
Associate&rsquo;s or Bachelor&rsquo;s degree</div></li><li><div>
AIC/CPCU Designations</div></li></ul><div></div><div>
Compensation: Salary is commensurate with experience and credentials.</div>
Pay Range: $81,124-$94,141<div></div><div><div><div><div><div><div><div><div>
Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses.</div></div></div></div></div></div></div></div><div></div><div><div><div><div><div><div><div><div>
Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.</div></div></div></div></div></div></div></div></div>

Complex Claims Specialist, Senior (Workers' Compensation)

<div><p>The WC Disability Claims Specialist manages within company best practices workers&rsquo; compensation claims to best possible outcome, supporting the goals of claims department and of CorVel. This role manages the claims toward closure and looks for settlement opportunities throughout reviews.</p>
<p>
This is a remote role.</p>
<p><b>
ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:</b></p>
<ul>
<li>Receives claims, confirms policy coverage and acknowledgement of the claim</li>
<li>Reviews for validity and compensability of the claim</li>
<li>Reviews and revises reserve and authorizes payments within reserving authority limits</li>
<li>Ensures timely and accurate payment of WC claim benefits, including indemnity and medical</li>
<li>Initiates investigations, including alive and well checks as needed to confirm continued payment of benefits</li>
<li>Manages workers&rsquo; compensation claims toward closure (targeted case load is 250&ndash;300 files)</li>
<li>Develops strategies and pursues settlement and/or claim closures, whenever possible</li>
<li>Communicates claim status with the customer, claimant and client</li>
<li>Adheres to client and carrier guidelines and participates in claim reviews, as needed</li>
<li>Additional duties as assigned</li></ul><br>
<p></p>
<p><b>
KNOWLEDGE &amp; SKILLS:</b></p>
<ul>
<li>Excellent written and verbal communication skills</li>
<li>Ability to learn rapidly to develop knowledge and understanding of claims practice</li>
<li>Analytical thinking: identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making</li>
<li>Computer proficiency and technical aptitude with the ability to utilize Microsoft Office, including Excel spreadsheets</li>
<li>Strong interpersonal, time management, and organizational skills</li>
<li>Ability to meet or exceed performance competencies</li>
<li>Ability to work both independently and within a team environment</li></ul><br>
<p></p>
<p><b>
EDUCATION &amp; EXPERIENCE:</b></p>
<ul>
<li>Bachelor&rsquo;s degree or a combination of education and related experience</li>
<li>State Certification as an Experienced Examiner</li>
</ul><ul><li>Minimum of 1 year of industry experience and claims management preferred</li>
<li>Preference for previous experience in WC disability benefit management</li></ul><br>
<p></p>
<p><b>
PAY RANGE:</b></p>
<p>
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.</p>
<p>
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.</p>
<p>
Pay Range: $43,886 - $65,638</p>
<p>
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management</p>
<p>
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.</p><br>
<p></p>
<p><b>
ABOUT CORVEL:</b></p>
<p>
CorVel, a certified Great Place to Work&reg; Company, is a national provider of industry-leading risk management solutions for the workers&rsquo; compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).</p>
<p>
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.</p>
<p><b>
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.</b></p>
<p>
#LI-Remote</p></div>

WC Disability Claims Specialist I - NY Pension PPD

<div><p>The Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers&rsquo; compensation claims under close supervision, supporting the goals of the Claims Department and of CorVel.</p>
<p>
This is a remote position.</p>
<p><b>
ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:</b></p>
<ul>
<li>Receives claims, confirms policy coverage and acknowledgement of the claim</li>
<li>Determines the validity and compensability of the claim</li>
<li>Establishes reserves and authorizes payments within established reserving authority limits</li>
<li>Communicates claim status with the customer, claimant and client</li>
<li>Adheres to client and carrier guidelines and participates in claims review as needed</li>
<li>Assists other claims professionals with more complex or problematic claims as necessary</li>
<li>Additional duties as assigned</li></ul><br>
<p></p>
<p><b>
KNOWLEDGE &amp; SKILLS:</b></p>
<ul>
<li>Excellent customer service skills</li>
<li>Excellent written and verbal communication skills</li>
<li>Fast learner; develops knowledge and understanding of claims practice, relevant statutes, and medical terminology</li>
<li>Ability to identify, analyze and solve problems</li>
<li>Computer proficiency and technical aptitude to utilize Microsoft Office, including Excel spreadsheets</li>
<li>Strong interpersonal, time management, and organizational skills</li>
<li>Ability to work both independently and within a team environment</li></ul><br>
<p></p>
<p><b>
EDUCATION &amp; EXPERIENCE:</b></p>
<ul>
<li>Bachelor's degree or a combination of education and related experience</li>
<li>Minimum of 1 year industry experience and claim handling</li>
<li>WC experience required</li>
<li>Licensed as required jurisdictionally</li></ul><br>
<p></p>
<p><b>
PAY RANGE:</b></p>
<p>
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.</p>
<p>
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.</p>
<p>
Pay Range: $16.74 - $26.92 per hour</p>
<p>
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management</p>
<p>
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.</p><br>
<p></p>
<p><b>
ABOUT CORVEL:</b></p>
<p>
CorVel, a certified Great Place to Work&reg; Company, is a national provider of industry-leading risk management solutions for the workers&rsquo; compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).</p>
<p>
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.</p>
<p><b>
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.</b></p>
<p>
#LI-Remote</p></div><p></p>

WC Medical Only Claims Specialist

RAS Companies

<div><p><b>Experienced Claims Representative &ndash; Workers&rsquo; Compensation</b></p><p>
We are seeking a <b>seasoned workers' compensation professional</b> to work with clients to control costs and exposure and help injured workers get back to work. In this position, you will handle workers&rsquo; compensation claims involving litigated, loss time and complicated medical claims. This position offers a <b>home-based work opportunity</b>.</p><p>
The successful candidate must reside in the state of MN or SD to be considered.</p><p>
A minimum of <b>three years of progressive workers&rsquo; compensation claims handling experience </b>to include handling litigated claims and files with larger losses is required</p><ul><li>
Proven decision making and problem-solving skills</li><li>
Excellent verbal and written communication skills</li><li>
Must be proficient in Microsoft Word and Excel</li></ul><p>
In our 30+-year history, we&rsquo;ve soared to great heights, reimagined ourselves, and gained a profound awareness of the value we bring as experienced workers&rsquo; compensation insurance providers. Today our reputation has grown as the region&rsquo;s <b>leading workers&rsquo; compensation insurance writer</b>. While our product is insurance, what we truly sell is safer workplaces, help for companies looking to protect their employees, and support for people at their most vulnerable.</p><p>
We offer a competitive wage and benefits package including medical, dental and vision coverage, paid holidays, paid parental leave PTO, 401K, and much more!</p><p>
At RAS, we believe in an inclusive work environment, where employees are welcomed, valued, respected, and heard to ensure that individuals bring their best selves to work. RAS provides equal opportunities to all qualified candidates without regard to race, color, religion, sexual orientation, gender identity or expression, age, disability status, veteran status, national origin, or any other status protected under federal, state or local law.</p></div>

Experienced Claims Representative – Workers’ Compensation

UFG Insurance

<div><p>UFG is currently hiring for a <b>Claims Specialist III</b> in <b>Workers Compensation</b>. This role is a highly experienced position primarily responsible for verifying applicable coverages, conducting timely and thorough research of the facts of a loss, analyzing compensability and evaluating benefits for reserve and settlement, and negotiating medium to high complexity claims to resolution in accordance with claims best practices.</p>
<p>
The Claims Specialist III &ndash; WC role demonstrates a strong desire to learn and grow, promotes a positive work environment, and embraces a strong service-oriented mindset in support of internal and external customers. This role requires strong communication skills, attention to detail, and the ability to handle multiple tasks efficiently and effectively. It also requires the ability to work independently with a low level of supervision and a high level of accountability. A strong desire to advance one&rsquo;s professional development and the development of others is essential to this role.</p>
<p><b>
Essential Duties and Responsibilities:</b></p>
<ul>
<li>Review claim assignments to timely determine policy coverage, compensability of a claimed injury or illness and facilitation of medical, indemnity and other statutory workers&rsquo; compensation benefits. If a coverage issue is relevant, review facts with a designated leader or mentor to determine a proper plan of action.</li>
<li>Make prompt, meaningful contact with insureds and their employees to research facts by conducting interviews; securing, understanding and synthesizing information from relevant documents; identifying other relevant parties to a claim; and proactively supporting all parties with their commitment to outcomes.</li>
<li>Establish rapport and an outcome focused relationship with insureds and their employees, as well as other internal and external stakeholders, through consistent on-going contact throughout the recovery process and claim resolution.</li>
<li>Request and analyze medical records to determine compensability according to evidence-based causation by jurisdiction. Have proficiency with conducting medical and legal research.</li>
<li>Interact with medical providers to clearly define medical causation and establish treatment plans focused on recovery.</li>
<li>Promptly and supportively inform insured and employees as well as other stakeholders of coverage and compensability decisions.</li>
<li>Support stay-at-work or return-to-work opportunities for insureds and their employees. Propose and facilitate vocational support when appropriate by jurisdiction.</li>
<li>Identify subrogation potential and document evidence in support of subrogation. Understand the subrogation mechanism and actively partner with internal and external subrogation partners to achieve outcomes with a goal to achieve global resolution.</li>
<li>Identify potential Medicare eligibility and comply with all Medicare Secondary Payor requirements of law. Have strong knowledge of Medicare settlement obligations.</li>
<li>Assess and periodically re-assess the nature and severity of injury or illness and design a plan of action focused on recovery and resolution in accordance with claims best practice guidelines by jurisdiction. Identify factors which could impact successful outcomes and collaborate on plans of action to mitigate impacts.</li>
<li>Assess and periodically re-assess claim file reserves to a high degree of accuracy. This will be achieved through understanding medical diagnoses and care plan developments; thorough analysis of wage information and accurate calculations of indemnity benefits; and by securing and providing job descriptions specific to the employee to medical providers. Promptly identify factors of risk for increased loss and expense costs.</li>
<li>Execute all technical claim handling functions such as documenting facts within the claims management system in a consistent, concise and clear manner; make timely decisions and promptly communicate decisions to stakeholders; process accurate benefit payments; and seek opportunities to mitigate claim handling expenses.</li>
<li>Proactively seek resolution of claims by defining stakeholder outcome expectations early and often, managing processes focused on outcomes and engaging in direct negotiation, mediation, settlement conferences or hearings according to jurisdiction. Proficient with seeking opportunities to overcome resolution barriers.</li>
<li>Comply with statute specific claims handling practices and reporting requirements.</li>
<li>Inform underwriting of increased hazards or unusual circumstances concerning a risk/policy exposure.</li>
<li>Participate in internal and external continuing education opportunities to maintain licensure and develop claim handling skills and abilities.</li>
<li>Demonstrate a supportive attitude and presence within the team by adapting well to change in process or procedure. Share innovative ideas to improve work product and outcomes. Take initiative to identify and learn about areas of professional development. Proactively seek out opportunities to collaborate with peers.</li>
<li>Demonstrate interest in one&rsquo;s own career development and actively support peers with their development.</li>
<li>This role requires a strong understanding of the insurance mechanism and interactions between business functions as well as strong support for initiatives that advance the goals of the enterprise.</li>
</ul>
<p><b>Job Specifications</b></p>
<p><b>
Education:</b></p>
<ul>
<li> High school diploma required.
</li><li>Post-Secondary education or Bachelor&rsquo;s degree preferred.
</li></ul><p><b>Licensing/Certifications/Designations:</b></p>
<ul>
<li>Meet the appropriate state licensing requirements to handle claims.</li>
<li> Within 1 year of hire, complete the Workers&rsquo; Recovery Professional (WRP) certification program.
 </li><li>Within 3 years of hire, complete the Senior Workers&rsquo; Compensation Law Associate (SCLA) designation program.</li>
<li> Willingness to pursue other professional certifications or designations as requested.</li>
</ul>
<p><b>Experience:</b></p>
<ul>
<li> 5+ years of general work experience.</li>
<li> 10+ years of workers&rsquo; compensation claims handling experience or a combination of workers&rsquo; compensation claims handling experience and experience in a related field.</li>
</ul>
<p><b>Knowledge:</b></p>
<ul>
<li>Proficient knowledge of insurance, medical and legal concepts is required with a high degree of ability to articulate knowledge verbally and in writing.
</li></ul><p><b>Skills and Abilities:</b></p>
<ul>
<li> Service-Oriented Mindset
</li><li>Clear and Concise Communication</li>
<li>Analytical and Critical Thinking</li>
<li>Attitude of Collaboration and Curiosity</li>
<li>Proactive Decision-making and Problem-solving</li>
<li>Time management and Sense of Service Urgency</li>
<li>Demonstrate aptitude for mentorship and leadership</li>
<li>Actively leads execution of claims initiatives</li>
</ul>
<p><b>Working Conditions:</b></p>
<ul>
<li> Working remote from home or general office environment.</li>
<li>Occasionally the job requires working irregular hours.</li>
<li>Infrequent overnight travel and weekend hours may be required.</li>
</ul>
<p><b>Pay Transparency Statement</b></p>
<p>
UFG Insurance is committed to fair and equitable compensation practices. The base salary range for this position is $71,598 - $94,396 annually, which represents the typical range for new hires in this role. Individual pay within this range will be determined based on a variety of factors, including relevant experience, education, certifications, skills, internal equity, geography and market data.</p>
<p>
In addition to base salary, UFG Insurance offers a comprehensive total rewards package that includes:</p>
<ul>
<li>Annual incentive compensation</li>
<li>Medical, dental, vision &amp; life insurance</li>
<li>Accident, critical Illness &amp; short-term disability insurance</li>
<li>Retirement plans with employer contributions</li>
<li>Generous time-off program</li>
<li>Programs designed to support the employee well-being and financial security.</li>
</ul>
<p>This pay range disclosure is provided in accordance with applicable state and local pay transparency laws.</p></div>

Claims Specialist III- WC

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