Primary Details

Time Type: Full time

Worker Type: Employee

The Opportunity

The role will manage a portfolio of complex claims by conducting loss investigations, evaluations and settlements on moderate to high level claims for the Accident and Health business unit.  Assures timely and accurate reserves.  Effective communication and collaboration with Underwriting, Actuary, Legal and Risk.  Working within specific limits and authority, conduct and coordinate loss investigations on technically complex claims to provide accurate facts for disposition.

Primary Responsibilities
• Implement the administration of insurance coverage to complex claims by conducting loss investigations, analyzing factual information, interpreting insurance policies and applying legal and technical knowledge to independently resolve claims files in a timely manner
•Negotiate claims settlements by collaborating with subject matter experts and involved parties, recommending appropriate reserve modifications for assigned claims and communicating solutions to mitigate risks and coverage conflicts and achieve cost effective outcomes
•Inform internal and external stakeholders on claims resolution processes by summarizing factual information, reporting out-of-scope, specialized exposures and accurately managing documentation of assigned claims to ensure effective communication of current state for individual claims portfolio
•Facilitate strong working relationships by communicating across the organization and reporting on approved, cost-effective claims strategies to ensure understanding of Claims operations and encourage a collaborative approach to enhancing the business
•Participate in claims specialist onboarding by sharing technical knowledge, recommending solutions to complex, escalated issues, training on department processes and procedures and demonstrating application of best practices to assist in development of new team members
•Support claims workflow efficiency by accurately documenting portfolio progress, referring high risk exposures outside authority levels and seeking opportunities that enhance operational knowledge to ensure achievement of individual and department objectives
•Ensure correct, cohesive and efficient customer solutions by collaborating and supporting team in decision-making to foster partnered approach to claims undertakings
•Establish a personal, empathetic connection with customers by providing comprehensive communication to ensure thorough understanding of available claims deliverables
•Contribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value “can do” people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun
 

Required Education
• Bachelor's Degree or equivalent combination of education and work experience
 

Required Experience
• 5 years relevant experience
 

Preferred Competencies/Skills
• Utilize effective communication to effectively influence and persuade decision makers; understand the needs and goals of customers and actively look for ways to meet them
•Mediate and resolve conflict using a logical approach
•Identify relevant information and understand it’s impact
•Maintain integrity of claims portfolio and evidence
•Use multiple resources to gather and analyze significant data
•Leverage technical knowledge to make cost-effective decisions
•Encourage open communication, cooperation and knowledge sharing
•High attention to detail
•Implement planning to organize, prioritize and measure individual work
 

Preferred Experience
• Experience in a claims department or the insurance industry
•Experience handling workers compensation claims
 

Preferred Licenses/Certifications
• Registered Nurse (RN)
 

Preferred Knowledge
• Working knowledge of claims administration best practices and procedures
•Working knowledge of insurance products and services
•Broad understanding of relevant laws and regulations across multiple jurisdictions
•Basic understanding of market trends and organizational strategies
•Working knowledge of Microsoft Office Suite, general computer software and database systems

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