Major Case Unit Claims Specialist

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The Specialist role of Workers Compensation, Major Case Unit will manage the investigation, litigation, disposition, and settlement of specialized claims, in compliance with corporate claim standards and procedures, and statutory, regulatory and ethics requirements. They will maintain, effectively create, and communicate file strategies, and plans for achieving optimum claim outcomes and demonstrate advanced technical and jurisdictional expertise.
This role will be a part of a team of 4 -5 Major Case Unit Claim Specialists as well as a Home Office Consultant. Timely and accurate reserving, Resolution and Settlement Strategies, Efficient, Timely and Accurate Investigations and Medical Management are responsibilities of this position. The position will also require strong written and verbal communication and presentation skills to ensure our internal and external customers are kept informed.   

Responsibilities:

• Maintain high standards and a clear understanding of goals for self

• Maintain action-oriented, confident approach to work assignments

• Stay current on issues impacting Workers’ Compensation including industry and marketplace trends, strategic direction of the organization, organizational structure and leadership, team goals and internal initiatives

• Use critical thinking skills to gather information, apply sound reasoning, draw appropriate conclusions, and make sound decisions based on a mixture of analysis, experience, and judgment

Claim File Management and Technical Expertise:

• Manage the completion and execution of the investigation, litigation, disposition, and settlement of specialized claims, in compliance with corporate claim standards and procedures, and statutory, regulatory and ethics requirements

• Accurately and timely assess the indemnity, medical and expense exposure of assigned Specialized claims and manage the accurate and timely setting of reserves

• Use organizational and communication skills to effectively manage the resolution of assigned claims, manage claim deadlines, and use resources appropriately

• Use claims functional knowledge to appropriately interpret and apply insurance coverage.

• Accurately resolve complex coverage and compensability issues

• Demonstrate advanced expertise to use case management practices to effectively reduce loss costs

• Manage claims consistent with our Knowledge Management Tool, Claims Excellence Standards and Performance Improvement goals

• Maintain current knowledge of claim loss cost containment initiatives, and use them appropriately and consistently with company practices and procedures to manage assigned claims

• Identify and initiate mitigation, subrogation, and other recovery opportunities on assigned claims

• Identify fraud indicators and initiate investigation on assigned claims

• Demonstrate technical and jurisdictional expertise

• Monitor financial results, trending and variances and identify, implement, and manage appropriate adjustments

• Communicate orally and in writing in a clear succinct manner

• Possess superior analytical and critical thinking skills, expert knowledge of complex medical terms, excellent time management abilities

• Properly apply statutory laws and regulations of applicable jurisdiction

Talent Management:

• Effectively hold self-accountable for achievement of business results

• Evaluate, acknowledge, and manage individual performance through the use of appraisal tools

• Effectively address and manage performance that does not meet required standards

• Management of individual’s professional and personal skill growth through the DNA program

• Mentor and share jurisdictional and technical knowledge with peers, as needed, in order to build capabilities within the supported field claim offices

Customer Service:

• Maintain dedication to meeting expectations and requirements of internal and external customers

• Obtain first-hand customer information and use it for improvements in products and services

• Establish and maintain effective relationships with customers, gaining their trust and respect

• Demonstrate diplomacy and tact to effectively avoid or diffuse high-tension situations

• Negotiate skillfully in tough situations with internal and external groups

• Set aggressive and realistic expectations for responding and follow through on commitment

• Always demonstrate professionalism and establish credibility when interacting with customers

• Personally enhance The Hartford’s reputation in the marketplace

• Treat all customers with respect and careful attention

• Clearly explain complex or technical information that is helpful to customers

Teamwork and Team Building:

• Contribute and support a team environment that achieves Claims’ Diversity and Inclusion initiatives

• Contribute to building a high performing team with diverse characteristics, where individual differences are valued

• Contribute to the building of appropriate rapport and constructive and effective relationships with people inside and outside the organization

• Represent The Hartford as a credible, trustworthy, flexible, and dependable resource.

• Demonstrate courtesy, honesty, integrity, respect, and competence when interacting with others

• Embrace role and offer advanced expertise to help teammates. solve problems, learn new skills, and accomplish goals

• Consistently act with the highest level of integrity and adhere to general principles of business ethics

Qualifications:

• Minimum of 5+ years of P&C- Workers Compensation claim industry experience required

• Strong technical understanding of Workers Compensation statutes and case law required

• Jurisdictional knowledge and experience strongly preferred to include NJ, IL, MD, NC, SC, VA, DC, DE, WV

• General Liability litigation experience is a plus

• Ability to be coached, guided, and mentored as you develop strategies on larger complex workers compensation claims

• State required certification exams and adjusting licenses

• SCLA or CPCU designation preferred

• Effective communication, interpersonal and negotiation skills. Ability to influence and communicate across multiple levels of the organization

• Established ability to execute including a proven track record managing complex projects and initiatives

• Strong analytical ability

• Bias for action and continuous improvement

• Demonstrated level of competency as described in Competency Profile and through DNA Badging

• Satisfactory completion of the candidate testing/certification process

• Ability to use computer technology to efficiently perform job functions

• Knowledge and experience using basic software program

• Bachelor’s degree preferred or 5+ years relevant work experience required

• State required certification exams and adjusting licenses as jurisdiction requires

Additional Information:
This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office locations (Hartford, CT, San Antonio, TX, Lake Mary, FL, Phoenix, AZ, Naperville, IL) will have the expectation of working in an office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise.

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford’s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

Equal Opportunity Employer/Sex/Race/Color/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

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