• To analyze mid- and higher-level workers compensation claims to determine benefits due. • Ensure ongoing adjudication of claims within company standards and industry best practices. • Identify subrogation of claims and negotiate settlements. • Develop and manage workers compensation claims' action plans to resolution. • Approve and process assigned claims, determine benefits due, and manage action plan pursuant to the claim or client contract. • Communicate claim action with claimant and client. • Ensure claim files are properly documented and claims coding is correct.

• Analyze complex or technically difficult general liability claims to determine benefits due. • Work with high exposure claims involving litigation and rehabilitation. • Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements. • Identify subrogation of claims and negotiate settlements. • Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. • Assesses liability and resolves claims within evaluation. • Negotiates settlement of claims within designated authority. • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

• Assists associates with leave of absence requests and guides them through the process • Processes all leave of absence paperwork according to established procedures and laws • Provides timely and accurate responses to associates and all levels of management concerning day-to-day issues and activities • Administer the FMLA policy • Review FMLA documentation for accuracy and completeness. • Make recommendations to approve or deny requests for FMLA based on federal regulations. • Coordinates correspondence, forms and other documents via the claim system • Contact Providers for clarification • Focus on customer experience to deliver the best experience for our customers • Demonstrated ability to deliver accurate, dependable, and trustworthy service to our customers.

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies. • Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing. • Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues. • Participate in ongoing training and professional development activities. • Maintain accurate and detailed records of claims processing activities. • Review claim forms and supporting documents • Determine eligibility, verify data accuracy • Request additional information when needed • Process claims end-to-end • Identify and escalate complex or unusual claims for further review or investigation. • Participate in ongoing training and professional development activities. • Handle more complex claims with multiple services, providers