Workers Compensation Specialist Resume Samples

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M King

Margie

King

286 Hillary Station

Phoenix

+1 (555) 340 8455

286 Hillary Station

Phoenix

Phone

p +1 (555) 340 8455

Experience Experience

Phoenix, AZ

Workers Compensation Claims Specialist

Phoenix, AZ

Hessel and Sons

Phoenix, AZ

Workers Compensation Claims Specialist

Manages Medical Only and Lost –Time Claims from inception to closure
Investigates claim to determine coverage and whether benefits are due and provides results of investigation to third party administrator adjuster. Responds to phone calls and written requests for information. Researches issues and gathers information specific to assigned territory
Monitors claim to determine benefits due and reserve accuracy within threshold authority
Evaluates and responds to third party administrator requests for settlement and reserve authority. Evaluates and provides authority for specialized claim services to help manage the claim (i.e. subrosa, nurse case management, independent medical exams, assignment of counsel etc.)
Coordinates Return to Work following Starbucks Return to Work Process
Audits and Reports Work Comp Leaves to Leave Administration team
Participates in claim review sessions with third party administrator

Philadelphia, PA

Complex Workers Compensation Technical Claims Specialist

Philadelphia, PA

Wisoky, Bartoletti and Wiza

Philadelphia, PA

Complex Workers Compensation Technical Claims Specialist

Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols
Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management
Confers directly with policyholders on coverage and resolution strategy issues
Establishes and maintains accurate reserves on all assigned files. Makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority
Establishes and maintains accurate reserves on all assigned files; makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority
Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insureds
Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insured

present

Dallas, TX

Workers Compensation Senior Claims Specialist

Dallas, TX

MacGyver, Casper and Beer

present

Dallas, TX

Workers Compensation Senior Claims Specialist

present

Reviews and administratively sets-up claims in software tracking system and writes or revises the brief description of loss to ensure that it accurately reflects the actual circumstances
Acts as senior technical professional on team, assisting team members with escalated issues. Mentors and trains new team members. Participates in Quality Review process
Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims
May coordinate elements of litigation efforts, or assume direct responsibility for select litigation efforts for development purposes, associated with assigned claims to ensure a timely and cost-effective resolution; may attend trails as a company representative
Investigate new claims by reviewing first reports of loss and supporting materials to determine the best initial contact; communicates with claimant, policyholders/customers, witnesses, etc
Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution; attends trials as a representative of the company
May assist in conducting closed file reviews to determine whether claims were processed in an effective and efficient manner; identifies areas for improvement, including reserving and leakage control

Education Education

Bachelor’s Degree

Johnson & Wales University

Bachelor’s Degree

Skills Skills

Proficient interpersonal skills; ability to interface with all levels of personnel
Proficient in Microsoft Office, including Word, PowerPoint, Excel
Strong negotiating skills
Proficient in using charts and graphs to provide visual support to meetings with business groups and internal and external reports
General knowledge of the legal process; experience in working directly with legal counsel
Understanding and experience with State Worker’s Compensation Funds; experience with Canadian and Puerto Rican Funds
Work collaboratively with JLL Claim Manager and internal business groups including Safety
Administrative and organizational skills, including time management

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Workers Compensation Claims Specialist Resume Examples & Samples

Manages Medical Only and Lost –Time Claims from inception to closure
Investigates claim to determine coverage and whether benefits are due and provides results of investigation to third party administrator adjuster. Responds to phone calls and written requests for information. Researches issues and gathers information specific to assigned territory
Monitors claim to determine benefits due and reserve accuracy within threshold authority
Evaluates and responds to third party administrator requests for settlement and reserve authority. Evaluates and provides authority for specialized claim services to help manage the claim (i.e. subrosa, nurse case management, independent medical exams, assignment of counsel etc.)
Coordinates Return to Work following Starbucks Return to Work Process
Audits and Reports Work Comp Leaves to Leave Administration team
Communicates claim action plans to claimants, physicians, field partners and third party administrator as required
Participates in claim review sessions with third party administrator
Acts as a liason between Risk and In-House Legal for any file requests and/or policy or procedure issues
Identifies and reports trends in claims to the risk control team to reduce the number and severity of claims
Organizes and maintains all necessary documentation for claim files in accordance to the Company Records Management Policy. Requests records for all parties as needed. Performs regular auditing of claim files to ensure compliance with client service instructions and standard claims adjusting practices
Maintains compliance with Company personal identification information policy
General office in a fast-paced environment (2 years)
Bachelor’s degree or equivalent level of work experience preferred
Basic skills in Microsoft Office Suite
Ability to provide customer service
Ability to manage time effectively and assign priorities to multiple assignments
Demonstrated interpersonal skills
Ability to work in a team environment

Workers Compensation Specialist Resume Examples & Samples

Understanding and experience with State Worker’s Compensation Funds; experience with Canadian and Puerto Rican Funds a plus
Proficient interpersonal skills; ability to interface with all levels of personnel
Proficient in Microsoft Office, including Word, PowerPoint, Excel
Proficient in using charts and graphs to provide visual support to meetings with business groups and internal and external reports
Strong negotiating skills
Work collaboratively with JLL Claim Manager and internal business groups including Safety
General knowledge of the legal process; experience in working directly with legal counsel
Administrative and organizational skills, including time management

Workers Compensation Claims Specialist Resume Examples & Samples

*This Claim Service Specialist position will specialize in wage-setting functions and will devote the majority of time to calculating/setting wages for injured workers and providing expertise in the area of wage-setting to BWC employees, injured workers, and other necessary parties.***
Or 36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 35 words per minute
Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self- insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information, & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law)
Or 24 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations) &/or as BWC Employer Service Representative, 63521, (i.e., providing information & assistance &/or responding to complaints, questions & inquiries from customers regarding workers' compensation coverage, established binder/applications maintenance, demographics, supplemental & legal entities, manual classifications, debits/credits & payroll reports &/or various BWC programs & research & explain employer refunds, attorney general balances, payments made to policies &/or divided credits)
Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims & paying medical claims for Ohio Bureau Of Workers' Compensation)
Or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &/or as Workers' Compensation Claims Assistant, 16720 &/or as Workers' Customer Service Representative, 64451 &/or as Workers' Compensation Employer Service Representative, 63521

Workers Compensation Associate Claims Specialist Resume Examples & Samples

Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (claimants, customers, witnesses, etc.) to gather information regarding injuries or loss; refers tasks to auxiliary units as necessary and posts file accordingly
Makes effective use of loss management techniques (e.g. Immediate Contact Plan, L9 check, Disability Management, open end release, first call settlements) and other resources
Licensing may be required in some states

Workers Compensation Senior Claims Specialist Resume Examples & Samples

Reviews and administratively sets-up claims in software tracking system and writes or revises the brief description of loss to ensure that it accurately reflects the actual circumstances
Acts as senior technical professional on team, assisting team members with escalated issues. Mentors and trains new team members. Participates in Quality Review process
Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages; determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners
Determines and documents, during the investigation process, the potential for subrogation, identifying applicable tort feasors and promptly placing them "on notice" of claim; refers claims to subrogation group upon recognition of potential recovery
May coordinate elements of litigation efforts, or assume direct responsibility for select litigation efforts for development purposes, associated with assigned claims to ensure a timely and cost-effective resolution; may attend trails as a company representative
Participates in the training of, and serves as a technical resource for, less experienced claims personnel
May participate in conducting Suit Committees, Roundtables, Arbitrations, Mediations and field investigations
Excellent interpersonal skills to communicate and negotiate with customers and conduct investigations required
Leadership ability and demonstrated time management skills to delegate work appropriately and organize resources effectively
Demonstrates an advanced knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the State's tort laws
A bachelor's degree (or equivalent training)
3 to 5 years directly related work experience

Workers Compensation Claims Specialist Resume Examples & Samples

Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages
Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims
BS/BA degree or equivalent work experience
Completion of formal training program or two years related experience required
Some experience in claims adjustment, general insurance or formal claims training
Required to obtain and maintain all applicable licenses
Pursuing continuing education courses leading to industry certifications (e.g., AEI, IIA, CPCU)
General knowledge of claims investigation techniques, medical and legal aspects of claims

Workers Compensation Technical Claims Specialist Resume Examples & Samples

Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management
Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols
Demonstrates the ability to understand key data elements and claims related data analysis
A Bachelors degree or equivalent business experience is required
WC Claims Handling experience and CA WC Certification

Workers Compensation & Leave Program Specialist Resume Examples & Samples

BA or equivalent + 3 years related experience, or MA + 1 year related experience
Implements and/or administers human resource policies, procedures, and programs in compliance with the NASA Shared Service Center's strategic plans and applicable corporate and legal requirements
High School Diploma or G.E.D. completed
Senior level knowledge and eight (8) years’ experience in human resources practices and principles
Ability to implements and/or administers human resource policies, procedures, and programs in compliance with the NASA
Shared Service Center's strategic plans and applicable corporate and legal requirements
Ability to apply comprehensive knowledge of Worker's Compensation and Leave Programs concepts, processes, practices and procedures
Highly skilled in using the information systems that support human resources services
Experience in processing Worker's compensation and unemployment Claims
Understanding local, state and federal disability laws

Complex Workers Compensation Technical Claims Specialist Resume Examples & Samples

Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure
Establishes and maintains accurate reserves on all assigned files. Makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority
Demonstrates the ability to understand new and unique exposures and coverages
Coordinates and participates in training sessions for less experienced staff, including both Complex & non-Complex staff
Demonstrated proficiency in Excel, PowerPoint as well as excellent written and verbal communication skill required
WC License for states required depending upon jurisdictions managed such as TX, OK, LA, etc…

Workers Compensation Claims Specialist Resume Examples & Samples

Assesses policy coverage for submitted workers compensation claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim
Plans and conducts investigations of workers compensation claims to confirm coverage and to determine liability, compensability and damages
Evaluates workers compensation claims for potential fraud and makes referrals to the Special Investigations Unit as appropriate
Assesses exposure associated with workers compensation claims and conducts negotiations, within assigned authority limits, to settle claims

Workers Compensation Medical Claims Specialist Resume Examples & Samples

3 courses or 9 mos. trg. or 9 mos. exp. in English composition or grammar; AND 3 courses or 9 mos. trg. or 9 mos. exp. in accounting, bookkeeping or general business mathematics; AND 3 courses or 9 mos. trg. or 9 mos. exp. in communication or public speaking or 9 mos. exp. involving contact with injured workers, employers, legislators, providers or their representatives & public; successful completion of one typing course or demonstrate ability to type 35 words per minute
Or 12 mos. exp. as Workers' Compensation Claims Assistant, 16720, (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self-insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law)
Or 12 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations)
Or equivalent of Minimum Class Qualifications For Employment noted above

Employee Experience Associate Specialist Workers Compensation Resume Examples & Samples

40%- Manage WSIB/Occupational Benefits
5%- Partner with local Health Services Departments to develop and document plant specific policies and procedures to ensure compliance with mandated programs of company and provincial organizations
10%- Ensure proper implementation of WSIB/Occupational Benefits claims handling and oversee third party administrator processes
20%- Coordinate employee injury management with the Health Services Manager
10%- Analyze WSIB claims data and collaborate with Health Services Department, Corporate Workers Compensation Managers, Human Resources, Safety, Operations and Plant Management to identify opportunities and implement actions to decrease liability in the Workers Compensation arena
5% - Collaborate with third party administrator and legal counsel
10% - Function as a liaison between injured workers and plant personnel to ensure effective communication and facilitation in the following areas: early and safe return to work, lost time management, restricted duty and case management
Demonstrated Ability to critical thinking, utilizing knowledge and legal guidelines to make appropriate decisions/recommendations
Computer Skills: Microsoft Word, Excel, PowerPoint, and Outlook
Must be legally entitled to work for Cargill in Canada

Employee Experience Associate Specialist Workers Compensation Resume Examples & Samples

40%- Manage Workers Compensation/Occupational Benefits
10%- Ensure proper implementation of Workers Compensation/Occupational Benefits claims handling and oversee third party administrator processes
10%- Analyze Workers Compensation claim data and collaborate with Health Services Department, Corporate Workers Compensation Managers, Human Resources, Safety, Operations and Plant Management to identify opportunities and implement actions to decrease liability in the Workers Compensation arena

Workers Compensation Claims Specialist Resume Examples & Samples

Manages an inventory of claims to evaluate compensability/liability
Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources
Negotiates settlement within authority limits; escalates to team manager as appropriate

Workers Compensation Senior Claims Specialist Resume Examples & Samples

Conducts all work activities associated with assuming full responsibility for managing a futurity of high exposure/complex claims which includes investigation and resolution of cases. Demonstrates ability to routinely handle increased level of authority
Participates in conducting Suit Committees, Roundtables, Arbitrations, Mediations and field investigations
May assist in conducting closed file reviews to determine whether claims were processed in an effective and efficient manner; identifies areas for improvement, including reserving and leakage control
Functions as the primary technical resource for the team in determining settlement authority, assessing best course of action for case resolution, handling inquiries, etc
Serves as the primary contact with policyholders/customers and establishes working relationship with customers. Responds to all types of general customer issues/problems. Conducts claims reviews and may periodically contact customers to determine needs and level of satisfaction
Demonstrated leadership ability and time management skills to delegate work appropriately and organize resources effectively
Demonstrates an expert level knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the State's tort laws as normally acquired through a bachelor's degree or equivalent training
4 to 6 years directly related work experience (at least two of which should ordinarily be in a team leader capacity)

Workers Compensation Associate Claims Specialist Resume Examples & Samples

Reviews and administratively sets-up claims in software tracking system and writes or revises the brief description of loss to ensure that it accurately reflects the actual circumstances
Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim
Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages
Determines and documents, during the investigation process, the potential for subrogation and refers claims to the subrogation group as appropriate
Evaluates claims for potential fraud and makes referrals to the Special Investigations Unit as appropriate
Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims
Alerts underwriting, marketing and/or risk management regarding questionable risks encountered to ensure that potential hazards are clearly documented
BS/BA degree or equivalent work experience
Completion of formal training program or two years related experience required
Some experience in claims adjustment, general insurance or formal claims training
Required to obtain and maintain all applicable licenses
Pursuing continuing education courses leading to industry certifications (e.g., AEI, IIA, CPCU)
General knowledge of claims investigation techniques, medical and legal aspects of claims

Workers Compensation Claims Specialist Resume Examples & Samples

Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages; determines need for, and requests authorization to engage, independent adjusters, cause and origin experts and independent medical examiners
Minimum of 2 years experience in claims adjustment, general insurance or formal claims training
Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU)
Knowledge of claims investigation techniques, medical terminology and legal aspects of claims

Senior Workers Compensation Claims Specialist Resume Examples & Samples

Performs or oversees the review and administrative set-up of claims in the software tracking system; assesses policy coverage and determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim
Plans and conducts investigations of claims to analyze and confirm coverage and to determine liability, compensability and damages; determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners as appropriate
Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution; attends trials as a representative of the company
Works with underwriting, marketing and/or risk management regarding questionable risks encountered to ensure that potential hazards are clearly documented
BS/BA degree or equivalent and 5+ years of Workers' Compensation Claims experience
Licensing required in certain states
Industry certifications preferred (e.g. AEU, IIA, CPCU)
Thorough knowledge of claims investigation techniques as well as medical and legal aspects of the claim
Financial settlement knowledge

Associate Workers Compensation Claims Specialist Resume Examples & Samples

Confirms or denies coverage based on facts obtained during the investigation and advises policyholders as to proper course of action
Demonstrated ability to build and maintain effective relationships
Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory

Workers Compensation Claims Specialist Resume Examples & Samples

Competitive pay
Recognition and incentive programs
Access to continuing education via the Kelly Learning Cente
Monday to Friday: Flexible hours with 9am to 3pm as Core
Requires 5+ years of handling complex workers compensation cases
Demonstrated commitment to claims career
Willing to take ownership and tackle obstacles to meet our quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation
Able to prepare and make exceptional presentations to internal and external customers
Use analytical skills to find mutually beneficial solutions to claims and customer issues
Important information: This position is recruited for by a remote Kelly office, not your local Kelly branch. Please submit your resume to be considered for this position by pressing the “SUBMIT RESUME” button below. If you have questions about the position, you may contact the recruiter recruiting for this position (DANR020@Kellyfinance.com), however, your resume should be uploaded via the “SUBMIT RESUME” button included within**

Workers Compensation Claims Specialist Resume Examples & Samples

Manage an inventory of claims to evaluate compensability
Investigate new claims by reviewing first reports of loss and supporting materials to determine the best initial contact; communicates with claimant, policyholders/customers, witnesses, etc
Bachelor's Degree or equivalent plus 3 to 5 years of Workers' Compensation claims handling

Workers Compensation Claims Specialist Resume Examples & Samples

Assume leadership role in the organization, complying with and assisting management in the administration of organization processes. Assist in the implementation of new processes and makes suggestions for improvements. Supports and helps Claims Management in its initiatives. Mentors other adjusters within the team. Helps coordinate service to members assigned with the team
The Claim Specialist will produce work of the highest quality. Files will demonstrate detailed investigation, analysis and evaluation of the most complex lost time cases through telephone or personal interviews with the injured employee, employer and all other pertinent parties. Documentation as the file unfolds is detailed, with proper action plans recorded. Continues to gather all pertinent data as long as claim file remains active
Evaluate data for compensability and establishes accurate case reserve based on approved reserving procedures. Reacts to events as they unfold in the file with proper reserve changes without fail. Properly completes Claim Summary Reports in a timely manner. Excellent negotiation skills, able to produce Section 32 settlements and claim stipulations as needed
Provide data to Case Management Team members and assists in the development of a treatment and return to work plan. Responsible for the implementation of the plan in conjunction with the Patient Advocate
Responsible for compliance with all regulations from the Workers’ Compensation Board including timely EDI and compliance reporting requirements and resolution of any EDI and/or compliance issues. Expert knowledge of Disability and Medical Treatment Guidelines. Mentor other case analysts for understanding and compliance to regulations and laws
Responsible for each case’s compliance with established service standards
Does the employee need to be bondable? Yes
Physical effort and dexterity -Occasionally the Claim Specialist will be required to lift and carry up to 15 pounds. Some stooping and kneeling will be necessary. Reaching and handling files, as well as keyboard and telephone operation, will be frequent activities
Visual acuity hearing and speaking -Speaking and hearing in ordinary conversation situations will occur frequently. Visual abilities need to include comfort with the PC screen and ability to see and read reports
Environment and scheduling -85% of the job is spent sitting down, either on the telephone or at a PC station. 10% is walking and the additional 5% is spent standing. 90% of this job will be performed inside and 10% outside. 35-hour workweek
Employee must already hold, or secure New York State Adjuster license within 90 days of appointment

Workers Compensation Claims Specialist Resume Examples & Samples

Maintain, document and update agency management system as needed and required for workers compensation claim activity and progress
Respond to claim inquiries and work to resolve problems with team and HUB clients
Review claim reports and other related documents
Follow up with insurance company claim representatives to resolve HUB client issues in a timely basis
Forward reports or follow up documentation to carrier or HUB clients when appropriate
Maintain claim diary system to follow on claim progress activities as needed
Assist and work with adjusters, team members and HUB clients to resolve claim issues
Inform claim manager/producer/account manager of payments and reserves over $25,000
Assist senior claim specialists to prepare claim reviews and executive claim summaries
Assist in employee and HUB client training as needed, included reporting procedures, claim best practices, transitional return to work, etc
Assist marketing/producers/account managers in gathering information for renewals
Provide backup as needed to run company loss data and distribute reports to HUB clients and internal team members
Participate in claim review meetings or conference calls with HUB clients, as needed
Perform other duties as assigned and follow claim process and agency procedures
Serve HUB clients, carriers and claimants who visit the agency
Participate in on-site HUB client meetings as needed
2-5 Years of Michigan Workers Compensation Claim experience and a comprehensive understanding of the Michigan Workers Compensation system
Workers Compensation Experience in other states is beneficial but not required
Complete CAWC (Certified Workers Compensation Authority) course within first year of employment, if requested
Work with a normal amount of supervision
Well organized with ability to prioritize daily workload
Aptitude for accuracy and details
Work normally scheduled hours and additional time, as needed

Workers Compensation Claims Specialist Resume Examples & Samples

Review and oversee the handling of all workers compensation claims for an assigned portfolio of Holiday communities
Work with Holiday’s third-party claims administrator, or TPA, to approve claim reserves and coordinate action plans for resolving claims
Oversee TPA claims management, including oversight of TPA adjusters and adherence to special handling instructions, claim handling best practices and Holiday’s culture and philosophy
Conduct regular claim reviews with Holiday’s TPA to ensure that claims are proactively managed to resolution and that established reserves accurately reflect the expected value of pending claims
Implement Holiday’s return-to-work program
Coordinate with Holiday’s Legal Department, Holiday’s TPA and local counsel in litigating denied or disputed claims
Compile and review claim data; identify risk exposures through evaluation of loss statistics and trends for the assigned portfolio of Holiday communities
Evaluate opportunities for risk reduction, risk transfer and risk avoidance
Work with Holiday’s Employee Relations, Safety, Legal and other departments to facilitate a holistic approach to safety and workers compensation losses
Provide support, training and leadership to Holiday communities and field leaders in the operation of the workers compensation program
Manage other administrative tasks as assigned by the Workers Compensation Manager
Must have 3+ years of experience managing workers compensation claims or equivalent experience managing general liability claims with a significant self-insured retention
Bachelor of Arts degree or equivalent experience required
Proficient in the use of Windows-based applications
Proficient in the use of Microsoft Office applications; ability to use Microsoft Excel to manipulate, analyze and display statistical data
Intermediate knowledge of enterprise-wide information systems and claim capture, or RIMS, platforms

Workers Compensation Senior Claims Specialist Resume Examples & Samples

Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (claimants, customers, witnesses, etc.) to gather information regarding injuries or loss; refers tasks to auxiliary units as necessary and posts file accordingly
Establishes action plans based on case facts, best practices, protocols, jurisdictional issues and available resources
Manages an inventory of property/casualty and disability claims (e.g. workers' compensation, general liability, commercial automobile, property, group benefits), evaluates compensability/liability and losses, and negotiates settlements within prescribed limits
Establishes accurate loss cost estimates using available resources, special service instructions, and market protocols
Confirms or denies coverage based on facts obtained during the investigation and advises policyholders as to proper course of action
Makes effective use of loss management techniques (e.g. Immediate Contact Plan, L9 check, Disability Management, open end release, first call settlements) and other resources
Effective interpersonal, analytical and negotiation abilities required
Ability to provide information in a clear, concise manner with an appropriate level of detail
Demonstrated ability to build and maintain effective relationships
Demonstrated success in a professional environment; success in a customer service/retail environment preferred
Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent
Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory
Licensing may be required in some states
Experience managing FL WC claims is highly desirable

Middle Market Workers Compensation Research Planning & Development Specialist Resume Examples & Samples

Incorporate pilot findings into product design as required with research team including
Lead implementation and adoption efforts with end users
Bachelor's Degree or higher
Strong analytical skills with aptitude for understanding foundational data and predictive models and a natural curiosity to interpret trends, draw conclusions and make recommendations
Proven record of creative and innovative thinking
Project management experience is required
Strong executive presence and presentation skills are a must
Candidate must be resilient and tenacious

Complex Workers Compensation Technical Claims Specialist Resume Examples & Samples

Investigates claims to determine whether coverage is provided, establish compensability and verify exposure; resolves claims within authority and makes recommendations regarding case value and resolution strategy to Branch Office Management and HO Examining on cases which exceed authority
Establishes and maintains accurate reserves on all assigned files; makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority
Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insured
Demonstrates the ability to understand new and unique exposures and coverage
Bachelor's degree or equivalent business experience required
Demonstrated proficiency in Excel and PowerPoint
Excellent written and verbal communication skill required
WC License for states required depending upon jurisdictions managed such as TX, OK, and LA

Workers Compensation Claims Specialist Resume Examples & Samples

Review and oversee the handling of all workers’ compensation claims for an assigned portfolio of Holiday communities
Coordinate with other members of Holiday’s risk management team to set strategic goals for managing complex claims
Work with Holiday’s Employee Relations, Safety, Legal and other departments to facilitate a holistic approach to safety and workers’ compensation losses
Provide support, training and leadership to Holiday communities and field leaders in loss mitigation strategies and the operation of the workers’ compensation program
Must have 5+ years of experience managing workers’ compensation claims in a large-scale, multi-jurisdictional workers’ compensation program
Familiarity with relevant federal and state safety laws preferred
Intermediate to advanced knowledge of enterprise-wide information systems and claim capture, or RIMS, platforms

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