Claims analyst

Job Description

The Claims Analyst, Senior Claims Analyst independently adjudicates multi-state workers’ compensation indemnity, EL and subrogation claim files that are generally non-catastrophic in nature.

ESSENTIAL FUNCTIONS

• Receives lost time assignments. Verifies and determines applicability of coverage.  Completes 24 hour contact with employer, employee and attending physician inclusive of telephonic contact, recorded statements and/or in person interviews with insured, employee, physician, and witnesses.
• Reviews all coverage issues and determines compensability within Midwest standards.  
• Aggressively manages all aspects of the workers’ compensation claims management process inclusive of litigation, and providing direction to defense counsel.
• Responsible for customer relations management, consistently establishing and maintaining high levels of trust and confidence with clients, through constant contacts, prompt response and resolving client’s questions and claim issues.
• Responsible for setting of reserves to Ultimate Probable Cost (UPC).Sets reserves for anticipated exposure subject to authority limits.
• Addresses timely benefit delivery including production of benefit notices to the injured party as required in the applicable jurisdiction. 
• Coordinates return to work (RTW) in accordance with the medical disability plan for the injured worker.
• Negotiates settlements directly with the injured worker or opposing counsel.
• Considers Medicare’s interests related to Conditional payments and injured workers eligibility and settlements.  
• Recognizes and manages 3rd party liability and subrogation through recovery.
• Reviews medical and expense bills for causal relationship and bill charges over $1500.00.
• Consults with Claim Supervisor/Claims Manager/Executive claims on files where assistance and consultation are needed.
• Completion of Claim Status reports.
• Makes assignments to nurse case management when indicated, monitoring their billing and performance.
• Coordinate claim review meetings with both internal and external parties.
• Attend hearings and depositions when required.
• All other duties as assigned.

Pay Details:

The base compensation range for this position is $45,000 - $55,000. This range reflects Acrisure's good faith estimate at the time of this posting. Placement within the range will be based on a variety of factors, including but not limited to skills, experience, qualifications, location, and internal equity.

Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.

 

Why Join Us:

At Acrisure, we’re building more than a business, we’re building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future.

Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York.

 

Employee Benefits

We also offer our employees a comprehensive suite of benefits and perks, including:

• Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.

• Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.

• Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.

• Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.

• … and so much more!

This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.

 

Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting leaves@acrisure.com.

 

California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy.

 

Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice.

 

Welcome, your new opportunity awaits you.