• Account Claims Representative

    Job Locations US-PA-Blue Bell
    # of Openings
    2
    Category
    Worker's Compensation
  • Overview

    Position Title:

    • Account Claims Representative

    Responsibilities:

    • Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature
    • Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)
    • Alerts Supervisor and Special Investigations Unit to potentially suspect claims
    • Ensures timely denial or payment of benefits in accordance with jurisdictional requirements
    • Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure
    • Negotiates claims settlements within granted authority
    • Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition
    • Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome
    • Maintains a working knowledge of jurisdictional requirements and applicable case law for each state serviced
    • Demonstrates technical proficiency through timely, consistent execution of best claim practices
    • Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues
    • Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account- specific sessions
    • Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.

     

    Requirements:

    • Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required
    • Associate in Claims (AIC) Designation or similar professional designation desired
    • Familiarity with medical terminology and/or Workers' Compensation
    • Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously
    • Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
    • Strong verbal, written communication skills and customer service skills gained through previous work experience
    • Computer literacy, including working knowledge of MS Office Product Suite, i.e. WORD, Excel, PowerPoint
    • Ability to travel for business purposes, approximately less than 10%
    • Working knowledge of Workers Compensation regulations for Pennsylvania jurisdiction.

     

    To Apply:

    • Please submit your applicant profile for review and a recruiter will be in contact with you within 24-hours.

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