Investigates and evaluates losses while developing a plan of action to bring claims to proper resolution in a timely manner. Experience level preferably between 5-7 years.
- Determines extent of insurance coverage and compensability on each filed claim
- Investigates claims, including interviewing employees, employers and witnesses
- Obtains necessary records, including but not limited to, hospital records, police reports, physician records, etc.
- EDI and CMS/Section 111 reporting
- Utilizes appropriate preferred vendors
- Presents thorough and accurate reports to clients and excess carriers on claims investigations/situations
- Negotiates settlements for resolutions with claimants and their attorneys
- Maintains control of litigation activities and costs per account requirements
- May be asked to mentor, train and/or share expertise with other staff
- May be asked to serve as back up to supervisor or manager when they are unavailable.
- Attends meetings; conferences; workshops or training sessions; and reviews written material to maintain current knowledge on principles, practices and new developments in assigned work areas
- Maintains and meets state specific licensing requirements
- Responds to client questions and comments in a courteous and timely manner
- Is responsible for catastrophic losses, complex litigation, and other sensitive issues
- All other duties as assigned
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
- Ability to understand and follow oral and/or written policies, procedures and instructions
- Ability to perform a wide variety of duties and responsibilities with accuracy and speed, while meeting time-sensitive deadlines
- Ability to conduct investigations in multi-party situations
- Ability to use standard or customized software applications appropriate to assigned tasks
- Ability to prepare and present accurate, reliable and factual reports with recommendations
- Thorough knowledge of current principles and practices associated with claims investigations, adjustment and related practices
- Extensive knowledge of medical and legal terminology with a thorough understanding of legal principles/litigation management
- Ability to handle confidential information
- Ability to communicate effectively with others both orally and in writing
- Ability and willingness to learn quickly and utilize new skills as a result of rapidly changing information and/or technology
- Ability to comprehend multi-state laws and regulations to assist other offices, as necessary
- REQUIRED EXPERIENCE: Should have 5-7 years’ experience in handling workers’ compensation claims. A college degree or equivalent business experience needed. Must have a current license in Nevada.
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