3CU - Senior Claims Examiner
Location: Baton Rouge, Louisiana
Description: Accident Fund Holdings, Inc. is presently looking of 3CU - Senior Claims Examiner right now, this occupation will be situated in Louisiana. For complete informations about this occupation opportunity kindly read the description below. This position will work with other key members of the team to develop and service niche market business in the defined region. The position will work wi! thin existing guidelines and Best Practices to deliver the 3CU value proposition. The position will involve leveraging knowledge and training across the three disciplines to assist in development, pre and post loss account servicing, and delivering superior outcomes with industry leading combined ratios. Multi-disciplinary teamwork is a cornerstone in the 3CU architecture.
Job Description and Qualifications:
RESPONSIBILITIES/TASKS:
Exercises significant discretion in the determination of compensability of workers compensation claims. Estimates the costs of personal injury, considering such factors as nature of injury, diagnosis, prognosis, earning capability, and the need for rehabilitation.
Proactively utilizes disability management software to assess diagnosis and related disability duration.
Evaluates work-related disabilities to determine appropriate referral for physician or nurse review. Proactively assists in appropriate return ! to work.
Estimates losses required to cover claims and cre! ates monetary reserves accordingly, within authority.
Investigates claims made by claimants for workers compensation injuries including 3-point contacts inclusive of interviewing policyholders, injured workers, medical providers, and communication with agents.
Taking recorded statements is a staple in our investigation process.
Onsite investigations are strongly encouraged, when appropriate.
Obtains all necessary documentation from the appropriate parties within established timelines.
Determines and manages necessary follow-up care; e.g., rehabilitation services, physical therapy, home care, etc. in collaboration with physician and/or nurse expertise.
Attends mediations and conducts on-site visits with self-insured, agent/client and/or injured parties.
Acts as trouble-shooter for complex issues that arise from the EDI system process. Assists in process development for paperless reporting (state driven).
Utilizes cost containment programs, too! ls, and strategies as appropriate.
Leverages the scalability of the Enterprise when appropriate.
Composes correspondence and various reports in the management of workers compensation claims.
Remains abreast of new case law decisions affecting workers compensation and disability management, and informs management of key changes in the law.
Ensures proficiency in litigation management and third party strategies and recoveries.
Determines needs for independent medical evaluations.
Update databases and prepares reports utilizing standard software.
Maintains confidentiality of information processed.
Perform other assignments at locations outside the office as needed.
Works autonomously.
Directs claims administration efforts within statutory, procedural, case law, contractual and/or philosophical guidelines
Manages the administration of complex claims and catastrophic exposures, within authority, including claims generated from dedicate! d large accounts
Negotiates and settles claims with claimants and/o! r attorneys, within authority, at the earliest proper point to bring cases to final disposition. Exercises sufficient and independent judgment to settle cases prior to mediation and/or litigation.
Actively participates in the agent/client management process; participates in securing new business and retaining existing business.
Develops relationships with agent/clients for the team's block of business
Assists in the development of agent/client planning, reporting, analysis and conducts education & training programs
Serves as liaison for the Regional Team with agent/clients in supporting case management initiatives
Engages in assisting the mentoring of other team members
Represents the Regional Team on various committees and projects
Provides leadership regarding case law understanding for regional team
Responsible for reporting claims to the Excess Carrier that meets excess reporting criteria in order to protect the client's exposure.
Man! age reserves on files that reflect the exposure for the client that will affect the loss portfolio.
Communicates with the client reserve changes and litigation management to protect their best interest.
Immediately communicates with the management team on catastrophic, severe traumas or questionable claims.
Work as a team to resolve potential excess exposure issues arising from a self insured or large deductible account.
Coordinates special projects of behalf of the management, as assigned
Mentors other employees
Conducts audits on claim files as directed.
Prepares reports as requested.
Researches and coordinates responses to account inquiries.
Identifies support team-staffing needs and take necessary measures to ensure appropriate levels of service.
Provides guidance and advice when required or necessary.
This position description identifies the responsibilities and tasks typically associated with the performance of the position.! Other relevant essential functions may be required.
EMPLOY! MENT QUALIFICATIONS:EDUCATION OR EQUIVALENT EXPERIENCE:
Bachelor's degree in insurance, business or related field is required. Progress towards, or completion of, industry-recognized professional designations preferred. Combinations of relevant education and experience may be considered.
EXPERIENCE:
The ideal candidate would have 15 years experience in handling workers' compensation claims.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Extensive knowledge of workers compensation insurance and the claims management process.
Ability to exercise good judgment in evaluating and determining the appropriateness of various actions within the process of claims management.
Ability to read, analyze and interpret policy documents, technical, legal, and financial information, and procedure manuals.
Excellent oral and written communication skills.
Excellent analytical skills to identify improvement needs and develop sol! utions.
Ability to interact with all levels of internal staff and management, and effectively exchange information clearly and concisely, present ideas, report facts and other information, and respond to questions as appropriate.
Strong interpersonal skills and the ability to negotiate while creating and maintaining mutually beneficial relationships with working partners.
Ability to manage multiple projects and meet necessary deadlines with minimal direction.
Ability to perform necessary mathematical computations.
Ability and proficiency in the use of computers and company standard software specific to position.
Ability to make competent, independent decisions.
Ability to maintain confidentiality.
Ability to perform other assignments at locations outside the office.
WORKING CONDITIONS:
Work is performed both in the office and in the field with minimal hazards. Travel (30% of the time) is required with occasional overnight ! stays. May be required to lift and carry computer equipment and other m! arketing promotional items weighing up to 35 lbs.
The qualifications listed above are intended to represent the minimal skills and experience levels associated with performing the duties and responsibilities contained in this position description. The qualifications should not be viewed as absolute standards, but as general guidelines that should be considered with other position-related criteria.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Accident Fund Holdings, Inc..
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This occupation will be started on: Wed, 11 Sep 2013 01:40:59 GMT
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