Claims Representative II

Company Details With over 35 years of proven expertise in the workers' compensation industry, Key Risk delivers innovative and responsive solutions that provide our clients the freedom to do what they do best. Offering guaranteed cost options to employers nationwide, Key Risk focuses on delivering products and services within specialized verticals to reduce workers' compensation exposures and deliver industry-leading results. Responsibilities The Workers’ Compensation Claims Representative III is responsible for the analysis and management of complex workers’ compensation claims. The ideal candidate must reside in Maryland. This position will review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims. It will process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. The representative acts in a fiduciary role on behalf of policyholders, negotiates claim settlements, and operates with the highest level of competency and sound judgment. Key Functions Analyzes and processes workers’ compensation claims by investigating and gathering information to determine exposure. Negotiates settlement of claims up to the designated authority level and makes claims payments. Calculates and assigns appropriate reserves to claims and manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves all claim payments; and settles claims within the designated authority level. Develops and manages claims through well‑developed action plans to bring the claim to a timely resolution. Prepares necessary state filings within statutory limits. Actively manages the litigation process to ensure timely and cost‑effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses cost containment techniques, including strategic vendor partnerships, to reduce overall claim cost. Communicates frequently with all appropriate parties involved with the claim. Maintains professional client relationships. Executes appropriate claims activities to ensure consistent delivery of high‑quality claims services. Qualifications 3+ years of MD and DC workers’ compensation claims handling experience preferred. In‑depth knowledge of workers’ compensation insurance principles and laws, preferably jurisdiction specific. May be required to obtain an adjuster license for other jurisdictions. Strong written and verbal communication skills. Strong interpersonal, time‑management, and organizational skills. Strong negotiation skills. Proven critical thinking skills that demonstrate analysis, judgment, and sound decision making with an emphasis on detail. Sense of urgency and ability to work independently and within a team environment. Ability to travel for business purposes, approximately less than 10%. Benefits Base Salary Range: $70,000 – $85,000. Eligible to participate in an annual discretionary bonus. Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k), and Profit‑Sharing plans. The actual salary for this position will be determined by factors such as scope, complexity, location, skills, education, training, credentials, experience, and other conditions of employment. #J-18808-Ljbffr