Investigates, evaluates and resolves complex and litigated workers' compensation claims in order to achieve prompt and appropriate outcomes. Provides a superior level of customer service to internal and external business partners. Administers and resolves claims in a timely manner and in accordance with legal statutes, policy provisions, and company guidelines.
- Promptly evaluates all assigned claims; establishes and executes a strategy to mitigate indemnity, medical and allocated loss adjustment expense exposure. Ensures timely disposition of all claims in accordance with regulatory and statutory requirements.
- Tracks status of assigned clams, individually and in the aggregate, using available management reports and tools such as Excel, including but not limited to such information as permanency evaluations, hearing dates, attorney information, settlement evaluation, venue, judges, current litigation status, subrogation credits due, and overall financial outcomes.
- Within granted authority, assures appropriate loss and expense reserves were established with documented rationale. Maintains and adjusts reserves over the life of the litigation to reflect changes in exposure, keeping in compliance with reserve authorization process. Notifies appropriate claim management when exposure exceeds authority. Negotiates claims resolution within granted authority.
- Establishes and executes appropriate action plans for claim resolution including loss cost management while achieving appropriate financial balance between allocated expense and loss outcome.
- Works collaboratively with multiple internal and external professionals and business partners in reaching appropriate disposition of all claims.
- Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome.
- Maintains a very strong working knowledge of applicable regulatory and jurisdictional requirements.
- Demonstrates technical proficiency through timely, consistent execution of best claim practices and established claims handling guidelines.
- Communicates effectively with internal and external customers on claims and account issues. Provides a high degree of customer service.
- Maintains and manages a diary system and claim pending to efficiently and effectively resolve all claims.
- Manages litigation to achieve appropriate financial outcomes. Effectively manages defense counsel to properly protect the insured and PMA interests.
- Participates with claims management in the counsel evaluation process of staff and panel counsel. Makes recommendations for the addition / deletion of counsel.
- Potential regional travel for attendance at hearings and trials.
- Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.
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- Must have NC License and experience handling NC Claims.
- Public entity experience strongly preferred.
- A minimum of 7 years of progressively responsible experience in handling complex workers compensation claims and workers compensation litigation required.
- Bachelor's degree desired.
- Strong level of expertise in commercial workers compensation coverage, evaluation and negotiation techniques.
- Strong organizational skills and detail oriented.
- Ability to work independently, prioritize workload, handle multiple tasks simultaneously and exercise good judgment.
- Working knowledge of workers compensation claims handling practices.
- Excellent verbal and written communication skills, including a strong ability to actively lead or participate in meetings, presentations and seminars
- Excellent customer service skills, with emphasis on accessibility and responsiveness.
- Computer literacy, including experience in Word, Excel and PowerPoint.
- Strong litigation management skills and extensive knowledge of applicable regulations, legislation and judicial decisions in relevant jurisdictions.