Senior Claims Representative Analyst; workers

Job Information

Job Title

S enior Claims Representative Analyst (workers' compensation)

Home Department:

Claims – Work Comp

Employment Status:

Exempt;
Full-time

Schedule:

40 hours/week with Flexible Scheduling Opportunities

Position Location:

Home Office, Telecommuting, and Remote Opportunities in: CO, GA, IL, IN, IA, MN, TN, TX, & WI

Protecting our policyholders’ dreams, passions, and livelihoods has a direct impact on the communities we serve. We work towards excellence, conduct ourselves with high integrity, and take our work seriously, but not ourselves. Small Details. Big Difference. Find out how you can make a difference with a career at Society.

Society Insurance is seeking an experienced Senior Claims Representative Analyst to join our workers' compensation team. This position will Independently resolve large and significantly complex claims by investigating losses and negotiating settlements. This role also works closely with Claims Manager, Senior Claims Quality Specialist, Compliance Manager, Claims Vendor Manager, and Claims Director to analyze jurisdictional changes and impacts on departmental and company guidelines and standards.

• Determines insurance coverage by examining claim forms, policies, and other records; interviewing claimants/injured workers, insureds, and witnesses; reviewing police and hospital records; and consulting with experts when appropriate.
• Handles and settles large and significantly complex claims by determining insurance carrier’s liability; reaching agreement with claimants/injured workers according to policy provisions and authority level; handling mediations, arbitrations, and subrogation within authority level.
• Provides departmental support by mentoring and training new and current claims representatives, shared claims staff, and interns.
• May support after-hours claims emergencies by being on call 24 hours per day, seven days per week.
• Keeps focus with continued file handling by collecting, analyzing and summarizing information, as well as making recommendations to managers regarding reserve changes and future handling of files over their authority level.
• Resolves questionable claims by investigating and comparing claims information with evidence.
• Manages litigated files and recommends litigation by analyzing negotiated settlement options and evaluating evidence.
• Manages file load composed of higher exposure and highly complex claims.
• Ensures company guidelines and procedures are followed by overseeing independent adjusters during investigations and attorneys in the handling of discovery and settlement.
• Ensures proper file documentation of assigned files by complying with claims handling guidelines and state requirements.
• Prepares reports by collecting, analyzing, and summarizing claim information.
• Contributes to team effort by participating on catastrophe teams; participating in determining department investigation guidelines; providing feedback to underwriting as needed; building relationships with agents; participating in evaluation and selection of vendors.
• Maintains professional, technical knowledge and expertise in a specified line(s) of business through training courses and participating in continuing education coursework/classes.
• Resolves litigated claims by referring cases to attorneys as needed, analyzing state statutes, evaluating evidence, and working with the attorneys in developing strategy for resolution of the case.
• Stays current on evolving state needs for the company, staff, and individual personal development. This may require travel to attend seminars, training opportunities, monitoring trade publications, and developing key relationships with…