Workers Compensation Technical Consultant

Drives Workers Compensation line of business results through file consultation with claim staff or counsel as needed, on files with coverage questions, high risk litigation, high risk exposure claims including complex file handling as well as participating in quality audits and provides line of business performance improvement recommendations / implementation plans.

Position Compensation Range:

$97,000.00 - $164,000.00

Pay Rate Type:

Salary

Compensation may vary based on the job level and your geographic work location. Relocation support is offered for eligible candidates.

Primary Accountabilities

• Drive line of business performance using data to assess needs, opportunities, issues and trends.

• Partners with data and analytics to review claim /policy data or hypothesis generated on loss trends or results as well as creates hypotheses based on observations within the industry, audit or file consultations for analysis. Helps provide the root cause analysis of loss results to stakeholders based on input from audit, industry trends, and file consultations.

• Oversee TPA claim operations or litigation programs and administer litigation matters.

• Provide consultative technical and authority guidance to file handlers, provide thought leadership on file risks and direction including jurisdictional, statutory, regulatory and technical expertise.

• Provide direct and or second level quality audits to ensure compliance with company objectives, guidelines, regulatory and statutory compliance.

• Identify and develop action plans to improve results through training and guidelines.

• Develop and deliver training as needed based on findings from data, file audits or guideline changes.

• Provide technical support to the claim areas on serious and complex liability, damages and coverage issues on claims where a demand is pending.

• Assist with special projects within the department.

• May be required to complete other assignments, job duties, or participate in projects based upon skills, achievements, or experience. 

Specialized Knowledge & Skills Requirements

• Demonstrated experience providing customer-driven solutions, support or service.

• Demonstrated ability to handle complex Workers Compensation claims and Coverage B claims.

• Extensive problem-solving skill.

• Demonstrated experience with Quality Audit.

• Extensive knowledge of policies and endorsements coverages.

• Extensive knowledge of workers compensation laws countrywide

Preferred Qualifications:

• A minimum of 10 years of experience in workers' compensation.

Licensing Requirements:

• Any required licenses must be obtained within the first 6 months of employment.

Travel Requirements

• Up to 10%.

• Catastrophe travel up to 75%.

Physical Requirements

• Work that primarily involves sitting/standing.

This is a hybrid role that involves working a minimum of 10 days per month in the office. Work locations for this role include: Madison, WI; Phoenix, AZ; Atlanta, GA. Internal candidates are encouraged to apply regardless of location and will be considered based upon the needs of the role.

#LI-Hybrid

• Your offer will be made contingent on the results of applicable background checks.

• Your offer is contingent on signing a non-disclosure agreement for proprietary information, trade secrets, and inventions.

• Our policy restricts consideration of applicants needing employment sponsorship (visa) to specialty occupations. Sponsorship will not be considered for this position unless otherwise specified in the posting.

The candidate(s) selected for this role will be employed by AFICS, Inc. (American Family Insurance Claims Services, Inc.), an affiliate of American Family Mutual Insurance Company, S.I.

At American Family Insurance Claims Services (AFICS, Inc.), we're embarking on a transformation of our claims capabilities to put customers at the center of what we do best – protecting and restoring their dreams when they need us most.

We encourage you to apply even if you do not meet all of the requirements listed above. Skills can be used in many different ways, and your life and professional experience may be relevant beyond what a list of requirements will capture. We encourage those who are passionate about what we do to apply!

We provide benefits that support your physical, emotiona