WC Claims Resolution Specialist – Special Risk Policyholders

• Manage workers' compensation claims for insureds with loss-sensitive insurance programs, including large deductibles and retrospectively rated policies
• Investigate losses, determine coverage, assess compensability, and review and analyze documents and legal pleadings
• Collaborate with legal counsel on litigated claims
• Develop and execute proactive claim resolution strategies, including damage evaluations, negotiations, and settlements
• Establish and maintain accurate claim reserves and communicate rationale and potential impact to insureds
• Identify and engage external resources while monitoring and controlling costs
• Partner with insureds, medical providers, and injured workers to facilitate safe and timely return to work when appropriate
• Collaborate with agents, policyholders, and internal stakeholders to analyze claims trends, implement risk mitigation strategies, and provide claims education
• Prepare and deliver claim summaries, reserve updates, and other analyses for agents and insureds
• Assess loss-sensitive insurance programs and communicate financial implications
• Mentor and train other claims handlers

• Bachelor's degree or equivalent combination of education and experience
• 5 years of experience handling workers' compensation claims of medium to high level of severity/complexity
• Ability to obtain appropriate state licensing as required
• Proficient computer skills, including Microsoft Office Suite
• Demonstrated ability to build positive relationships and partnerships within the department, across the organization, and with external customers
• Strong analytical skills and attention to detail
• Excellent verbal and written communication skills
• Ability to interact with internal and external customers
• Ability to travel overnight up to 15%
• Texas expertise; ideally Arizona, Arkansas, and Oklahoma expertise

Demonstrates expertise in managing workers' compensation claims, including loss-sensitive insurance programs, while effectively collaborating with legal counsel and stakeholders. Proficient in developing claim resolution strategies and maintaining accurate claim reserves to support insureds.

• Workers' Compensation Claims Management
• Loss-Sensitive Insurance Programs
• Analytical Skills
• Communication Skills
• Texas Expertise

• Claims Investigation
• Coverage Assessment
• Damage Evaluation
• Negotiation
• Settlement Strategies
• Claims Trend Analysis
• Risk Mitigation Strategies
• Claims Education
• Claim Reserve Management
• Document Review

• Relationship Building
• Attention to Detail
• Collaboration
• Mentoring
• Customer Interaction

• State Licensing

• Workers' Compensation
• Loss-Sensitive Insurance
• Legal Collaboration
• Claims Handling
• Return to Work Programs
• Claims Summaries
• Financial Implications
• Medium to High Severity Claims
• Texas Expertise
• Claims Reserves

• Microsoft Office Suite