- 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.
- 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.
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