Investigates, evaluates, and handles assigned claims through final disposition in accordance with company procedures. Investigates coverage and compensability issues.  Handles lost time claims to include medical case management, litigation management, return to work and settlement where necessary.  Uses technology and systems to manage claims, to include document management, utilization review, and pharmacy management.  Develops skillset to pro-actively manage caseload, to include time management, decision makings skills, and having difficult conversations.

• Investigates assigned claims following sound claim handling techniques in accordance with company claim philosophy and quality assurance standards. 
• Responsible for investigating and determining coverage, compensability, and subrogation potential on every claim, including second injury fund and longshore 8(f) special fund. 
• Determines proper jurisdiction and classifies each claim under state, federal or maritime class codes.
• Establish and adjust reserves or provide reserve recommendations to establish the value of the claim consistent with corporate policies and within assigned authority levels
• , Evaluates and negotiates settlements of claims within assigned authority level.
• Manage all litigation issues arising under assigned claims, to include coverage, compensability, medical causation, return to work issues, and any other issues under the law. 
• Responsible for medical case management, utilization review, return to work, pharmacy management and settlement/mitigation when necessary.
• Continuous communication with injured workers, policyholders, agents, medical providers, plaintiff attorneys and defense attorneys.
• Heightened focus on learning applicable laws, regulations and medical guidelines. 
• Documents claim files with necessary information to confirm all claim issues.  Provides appropriate level of service to agents and policyholders.
• Complies with all customer service standards.  Responds promptly to resolve complaints or claim problems. Manages personal claim caseload effectively and in accordance with productivity and claim cost objectives.
• Performs other job duties as dictated by office circumstances.

• Strong character
  • Alignment with company values, mission, and vision
  • Trustworthy and honest
  • Decisive
  • Curious and persistent
  • Commitment to accountability
• Passion for innovation
  • Willingness to learn
  • Adaptive to changing (tolerance for ambiguity)
  • Desire to collaborate to achieve corporate goals
• Strong communicator
  • Effective communication skills
  • Empathetic listener and open-minded
  • Focus on customer service and stakeholder experience
  • Effectively handle difficult conversations
  • Effective use of persuasion

Education and Experience

• Education Required:
  • Bachelor’s degree and a minimum of 2 years handling of workers’ compensation claims, or 4 years of experience as an insurance claims adjuster.
  • OR
  • High School Diploma/GED with 2 years handling of workers’ compensation claims and 4 years of experience as an insurance claims adjuster.
• Skills Required:
  • Communication, computer literate, math, judgment and problem-solving skills.

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