Workers' Claim Representative II - Eastern Alliance

An exciting opportunity exists to join the Pro Assurance family of companies! Our mission is powerful and simple:
We protect others. Choosing a place to apply your talents is an important decision for anyone. You have plenty of options. Why choose Pro Assurance? At Pro Assurance, we sell a pledge, and that pledge is delivered by our team members. We are seeking individuals who value integrity, leadership, relationships, and enthusiasm—and want to build their career with a great company where they can be their authentic self and feel valued, recognized, and rewarded for their contributions.

Pro Assurance specializes in healthcare professional liability, products liability for medical technology and life sciences, legal professional liability, and workers' compensation insurance. We are an industry-leading specialty insurer, with job opportunities in much of the contiguous United States. This position supports our workers' compensation line of business, Eastern Alliance, and is hybrid, based out of Carmel IN.

The primary responsibility of this position is to consistently execute the Company’s ecovery® Return to Wellness philosophy and business model that leads to better outcomes for our injured workers and insureds. Responsibilities of this position include managing all aspects of assigned claims, including verifying coverage, investigating, managing, and resolving workers’ compensation claims (medical only and lost time) for the Company’s customers under direct supervision, following established Company requirements and procedures, and promptly establishing and maintaining accurate reserves with an authority limit of up to $50,000 all in support of the Company’s revenue and profitability objectives and overall business plan.

• 45% - Complete ongoing claim management activities proactively and with a sense of urgency in accordance with the ecovery® Return to Wellness philosophy to execute the established plan of action and achieve favorable outcomes for all parties. Maintain, cultivate, and develop high quality, collaborative working relationships with all parties, including injured workers, agents, customers, and co-workers. Maintain regular contact by telephone and correspondence with all parties.
  
  Seek complete information necessary to manage claims and achieve favorable outcomes. Respond to inquiries in a timely, courteous, and professional manner.
• 30% - Promptly investigate all assigned claims to establish trust and rapport with all parties, accurately assess coverage, determine the nature and extent of the injuries sustained, and reinforce Return to Wellness expectations. Make fair and timely determinations of compensability. Demonstrate empathy, professionalism, integrity, and objectivity at all times. Prepare reports and forms as required by jurisdictional regulations and by the Company’s established procedures.
  
  Promptly establish and maintain case reserves that accurately reflect the anticipated financial exposure on each claim; revise reserves promptly based on changes in facts and circumstances. Identify subrogation potential.
• 15% - Manage Return to Wellness initiatives by working collaboratively with agents, clients, risk managers and underwriters to ensure proper return to work guidelines and procedures are established,followed and achieved.
• 5% - Attend business unit, department and company meetings.
• 5% - Assist with Company projects as assigned and continue professional growth and development through the attendance and participation in insurance related events/ functions, seminars, classes and conferences.

• Bachelor’s degree is preferred; a HS Diploma/GED with a minimum eight years of experience working in a medical, legal or insurance environment can replace the bachelor’s degree requirement.
• Basic knowledge of medical terminology, common medical procedures and treatments is required.
• Some knowledge of applicable state laws and industry standards is required.
• Proficiency in Microsoft Office computer applications, including Word and Excel, and ability to learn new computer software applications.
• Attention to detail in processing all information,…