The Claim Specialist investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. (Supervisor will determine actual individual authority up to the stated maximum). Conducts training classes (including research and position papers) for less experienced Claim Department Representatives. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.
This position will be working specifically with South Carolina and Florida claims. Experience in both of these states is ideal.
Principal Duties and Responsibilities
* **Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure. Maintains contact throughout the life of the file as needed.
* **Administers the delivery of timely, appropriate and accurate indemnity and medical benefits.
* **Evaluates claim exposure, negotiate and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration and hearings, as necessary. Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.
* **Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling.
* **Maintains quality claim files in accordance with appropriate best practices, and other company procedures.
* **Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate.
* **Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate.
* Stays current on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same.
* Prepares and presents files for Agent/Broker Reviews and Insured File Review.
* Understands medical terminology and standard medical procedures as they pertain to worker’s compensation, U.S. Longshoreman’s and Jones Act claims.
* Participates in in-house and outside training programs to keep up-to-date on relevant issues/topics.
* Maintains a working knowledge of all computer systems currently in use.
* Travels throughout the States as required to handle claims inventory assigned.
* Continues education in claims through Associate in Claims or Claims Law (AEI) courses.
Requirements:
Our comprehensive benefits package includes all traditional offerings such as:
We also offer other benefits to help foster a healthy, balance lifestyle such as:
MEMIC is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, ancestry, age, disability, genetics, gender identity, veteran's status, sexual orientation, or any other characteristic protected by law.