Claims Representative II

Workers' Compensation Claims Representative III

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. The position will process, and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. Acts in a fiduciary role on behalf of policyholders and negotiates claim settlements. Claims Representative III conducts the handling of claims in the utmost of good faith in compliance with the rules, regulations and state statutes. The Claims Representative III is expected to function with a high degree of competency. The use of sound judgment coupled with technical claim handling skills and consistent results are expected.

Key Functions will include but not be limited to:

• Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
• Negotiate settlement of claims up to designated authority level and makes claims payments.
• Calculates and assigns timely an appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level.
• Develops and manages claims though well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
• Prepares necessary state filings within statutory limits.
• Actively manages the litigation process; ensures timely and cost-effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
• Frequently communicates with all appropriate parties involved with the claim.
• Maintains professional client relationships.
• Actively executes appropriate claims activities to ensure consistent delivery of quality claims services.

Qualifications

• 3+ years of MD and DC workers compensation claims handling experience preferred
• In depth knowledge of appropriate insurance principles and laws of workers' compensation, preferably jurisdiction specific.
• May be required to obtain 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 demonstrates analysis/judgment and sound decision making with focus on attention to detail.
• Ability to perform with a sense of urgency.
• Ability to work both independently and within a team environment.
• Ability to travel for business purposes, approximately less than 10%.

Additional Company Details

We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $70,000 – $85,000 • Eligible to participate in 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 a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Sponsorship Details

Sponsorship not Offered for this Role