WC Claims Resolution Specialist - Special Risk Policyholders

WC Claims Resolution Specialist Special Risk Policyholders

Amerisure creates exceptional value for its partners, policyholders, and employees. As a property and casualty insurance company, Amerisure's promise to our partner agencies and policyholders begins with a comprehensive line of insurance products designed to protect businesses, as well as the health and safety of every employee. With an A.M. Best "A" (Excellent) rating, Amerisure serves mid-sized commercial enterprises focused in construction, manufacturing and healthcare. Ranked as one of the top 100 Property & Casualty companies in the United States, we proudly manage nearly $1 Billion of Direct Written Premium and maintain $1.21 billion in surplus.

Amerisure is currently recruiting for a WC Claims Resolution Specialist Special Risk Policyholders. This role will be hybrid in an office 2 days a week (Tuesday & Wednesday). This role requires Texas expertise, and ideally Arizona, Arkansas and Oklahoma. The ideal candidate will possess the following skill set.

Summary Statement

Manage workers' compensation claims for insureds with loss-sensitive insurance programs, such as large deductibles and retrospectively rated policies. Conducts thorough investigations, evaluates claims, and ensures effective resolution while delivering exceptional customer service to insureds with loss sensitive insurance policies. Builds robust relationships by demonstrating strong analytical, negotiation, and communication skills, with a focus on delivering quality claim outcomes and excellent service.

Essential Tasks/Major Duties

• Investigate losses, determine coverage, assess compensability, and review and analyze documents and legal pleadings.
• Collaborate with legal counsel to manage litigated claims, leveraging experience to analyze documents and legal proceedings effectively.
• Develop and execute proactive claim resolution strategies, including timely damage evaluations, negotiations, and settlements in accordance with guidelines.
• Establish and maintain accurate claim reserves to reflect financial exposure, ensuring clear and proactive communication with the insured regarding rationale and potential impact.
• Identify and engage external resources as needed to facilitate proper claim resolutions while monitoring and controlling costs.
• Partner with insureds, medical providers, and injured workers to facilitate a safe and timely return to work when appropriate.
• Collaborate proactively with agents, policyholders, and internal stakeholders to analyze claims trends, implement risk mitigation strategies, and provide claims education.
• Prepare and deliver detailed claim summaries, reserve updates, and other analyses for agents and insureds.
• Understand and assess loss-sensitive insurance programs, such as large deductible or retrospectively rated policies, keeping insureds informed of financial implications.
• Mentor and train other claims handlers.

Knowledge, Skills & Abilities

• Bachelor's degree or equivalent combination of education and experience.
• 5 years of experience handling workers' compensation claims of medium to high level of severity/complexity.
• Ability to obtain appropriate state licensing as required.
• Proficient computer skills required including Microsoft Office Suite.
• Demonstrated ability to build positive relationships and partnerships within department, across the organization and with external customers.
• Strong analytical skills and attention to detail.
• Excellent verbal and written communication skills with the ability to interact with internal and external customers.
• Ability to travel overnight up to 15%.