Education and/or Experience: Bachelors Degree or 8+ years claim experience.* 10 Years of Litigation Experience and FL Presumption Law Experience a plus*
Excellent oral and written communication skills.
Initiative to set and achieve performance goals.
Good analytic and negotiation skills.
Ability to cope with job pressures in a constantly changing environment.
Knowledge of all lower level claim position responsibilities.
Must be detail oriented and a self-starter with strong organizational abilities.
Ability to coordinate and prioritize required.
Flexibility, accuracy, initiative and the ability to work with minimum supervision.
Discretion and confidentiality required.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
The Workers' Compensation Claim Consultant, Senior, is responsible for the investigation and adjustment of assigned claims. Accountable for the quality of claim services as perceived by CCMSI clients and within our corporate claim standards.
Investigate, evaluate and adjust claims in accordance with established claim handling standards and laws.
Establish reserves and/or provide reserve recommendations within established reserve authority levels.
Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims. Negotiate any disputed bills or invoices for resolution.
Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
Assist in the selection, referral and supervision of designated claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
Review and maintain personal diary on claim system.
Assess and monitor subrogation claims for resolution.
Prepare reports detailing claim status, payments and reserves, as requested.
Provide notices of qualifying claims to excess/reinsurance carriers.
Conduct claim reviews and/or training sessions for clients, as requested.
Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
Performs other duties as assigned.