Compassion, trusted partnerships, and relentless commitment to workforce safety
Claim Specialist III
Location
United States
Posted
9 hours ago
Salary
0
Seniority
Senior
Job Description
Claim Specialist III
MEMIC
• 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. • 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. • Serves as a mentor and helps prepare/train the less experienced Claim Department representatives. • Keeps up-to-date 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 States as required to handle claims inventory assigned. • Continues education in claims through Associate in Claims or Claims Law (AEI) courses.
Job Requirements
- Three years of workers’ compensation lost time and medical only claim handling experience preferred.
- Bachelor’s degree preferred.
- Computer skills, Word, Excel and Image Right preferred.
- Must have a valid driver’s license.
- Strong attention to detail and strong communication skills both verbal and written.
- Adaptable/flexible and self-directed with the ability to manage time, multiple priorities and other resources wisely.
- Must have the ability to work effectively with other organizational team members.
Benefits
- Health Insurance options, Dental Insurance options and Vision Insurance
- Employee Life Insurance/AD&D and Dependent Life Insurance options
- Short-term & Long-term Disability
- Health Savings Account with potential employer match
- Flexible Medical and Dependent Care Account
- Accident Insurance
- Critical Illness Insurance
- Employee Assistance Program
- Legal/Identify Theft Insurance options
- Long Term Care Insurance
- Pet Insurance
- 401 (k) Retirement Plan with match up to 6%, plus annual bonus based on individual & company performance.
- 5 weeks of Paid Time Off (PTO)
- 11 paid holidays
- Flextime schedules
- Paid Parental Leave
- Student loan paydown and refinancing assistance
- Educational assistance for job related courses, seminars, certifications or degrees
- One paid day every year to volunteer for your non-profit of choice
- Sit-Stand desks & daily stretch breaks
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