Mon - Fri / 8am - 5pm
The Claims Analyst independently adjudicates California or multi-state worker's compensation indemnity claim files that are generally non-catastrophic in nature.
- Independently adjudicates California or multi-state workers’ compensation indemnity claim files that are non-catastrophic in nature, claim exposures up to $100,000 incurred reserves within branch authority, and some catastrophic claim handling, in accordance with jurisdictional requirements, and Midwest Claims Practices.
- Conduct timely investigations, including obtaining telephonic/recorded statements, in person interviews, contact with insured, employee, physician, attorney, witness.
Handle and review coverage issues, determine compensability, schedule appropriate exposure, and address timely benefit delivery.
- Recognition of 3rd party liability, and subrogation handling through recovery.
- Identify and review the need for medical case/vocational management to a specific loss, and direct/manage activity relative to managed care.
- Interface and manage handling with defense attorneys and investigative vendors when presence is required. Litigation experience is required, and control to the extent we can no longer act in the presence of counsel. Direct settlement resolution with the injured worker and/or with opposing counsel will be expected. Litigation management from initial Arbitration to the Supreme Court level is required. Attendance may be required at hearings, on cases of larger exposure, and/or when testimony is required. Client visits will be required depending on special handling parameters as defined in our best practices, account special handling instructions, or at the discretion of the Unit Manager. Status report completion is required on claims greater than or equal to $50,000.
- Good listening; and good written and communication skills.
- Ability to work independently and stronghold the understanding of human nature and motivation principles.
- Readily control/handle problem issues in times of stress, and/or in a climate of conflict or adversity.
- Ability to document claim file activities is required.
- Responsiveness to changing business or customer needs.
- Bachelor’s degree and/or 2-5 years relevant claims adjusting experience in the workers’ compensation field is preferred, but not required.
- Relevant state licensing where required.
- Computer literacy; familiarity with Microsoft Office a plus.
- This individual will adhere to the code of ethical conduct and is required to engage in fair claims settlement practice.