01Responsibilities
Assign medical or other experts to case and arrange for medical examinations when necessary.
Develop lost time claim disposition skills under limited direction of supervisor.
Pro-actively manages the case resolution process. May participate in mediations within limit of settlement authority.
Ensure proper referrals and timely updates to appropriate Reinsurer(s).
Actively participate in claim reviews with clients.
Timely analyze information in order to evaluate assigned claims to determine the extent of loss.
Manage the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment under limited direction of supervisor.
Communicate claim status with the injured worker, clients, and broker as needed.
Effectively evaluate, negotiate and resolve claims within delegated authority utilizing the appropriate denials or releases.
Establish appropriate reserves and review on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level.
Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, clients, witnesses and others having pertinent information.
Provide required reports to AVP, Claims, Underwriting, Reinsurance and Actuarial on significant exposure cases.
Appropriate state licensing to be obtained for assigned jurisdictions.
Effectively evaluate and resolve coverage issues for all Workers' Compensation claim types.
Effectively and efficiently manage vendors and expenses.
Participate in monthly account renewal meetings as needed.
Mentoring and training new employees as appropriately assigned by management.
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