Senior Claims Representative

Investigates, evaluates, and proactively manages assigned claims of variable complexity through final disposition. Investigates coverage and compensability issues.  Handles lost time claims to include high IWIS claims, high exposure claims, as well as claims for assigned special accounts. Will have increased reserve and settlement authority limits. Handling of claims to include medical case management, litigation management, return to work and settlement where necessary. Serves as a resource and mentor to members of the department. Uses technology and systems to manage claims, to include document management, utilization review, and pharmacy management.  Claims assigned will be handled independently under general direction according to the established policies, procedures, and precedents.

• Serve as dedicated claims representative to handle special customer service requirements for assigned accounts.
• Proactively manage litigated claims with in-house legal or outside counsel with focus on timely resolution and/or settlement. 
• Evaluate and settle all claims with settlement potential within increased authority limits and present claims exceeding authority levels to executive claims committee for resolution of large exposure claims.
• Responsible for investigating and determining coverage, compensability, and subrogation and second injury fund potential, as well as resolving unique coverage issues where coverage may involve multiple carriers or claims involving employers’ liability exposure.
• Manage occupational disease claims and any other claims involving extraordinary claim issues, to include high IWIS claims and other high exposure claims.  
• Manage personal caseload effectively to mitigate exposure within controllable claim cost objectives.
• Develop cost containment strategies for large claims and make recommendations for productive case outcomes.
• Document claim files in accordance with quality review standards and complete reinsurance reporting on high exposure claims.
• Approach job in a conscientious, mature fashion demonstrating a sense of responsibility.  Exhibit an ethical manner of conduct and keep sensitive information confidential.  Demonstrate a willingness to contribute whatever is necessary to get the job done.
• Investigate larger more complex workers’ compensation claims following sound claims handling techniques in accordance with company claim philosophy and quality assurance standards.
• Establish and maintain appropriate file reserves with increased authority limits that accurately reflect file exposure in accordance with company file reserving procedures.
• In addition to continuous communication with injured workers, medical providers, plaintiff attorneys and defense attorneys, also provides an appropriate level of customer service to policyholders and agents and promptly responds to resolve complaints or claim problems.
• Resource for and mentor to less experienced claims representatives.
• Provides other job duties as dictated by office circumstances.

• Strong character
  • Alignment with company values, mission, and vision
  • Trustworthy and honest
  • Decisive
  • Curious and persistent
  • Commitment to accountability
• Passion for innovation
  • Willingness to learn
  • Adaptive to changing (tolerance for ambiguity)
  • Desire to collaborate to achieve corporate goals
• Strong communicator
  • Effective communication skills
  • Ability to navigate difficult conversations
  • Empathetic listener and open-minded
  • Focus on customer service and stakeholder experience
•  Analytical skills
  • Mathematics/analytical background       
  • Investigation skills
  • Negotiation skills
  • Problem solving skills
  • Time management skills

• Education
  • Bachelor’s degree and four years handling workers’ compensations claims. OR High School Diploma/GED with eight years of insurance claims handling experience, four of which being workers’ compensation claims.
  • Active Louisiana Workers' Compensation Adjuster License required prior to start or obtained within seven (7) business days after start date.
• Experience
  • Minimum of two years as a Claims Representative strongly preferred
  • CPCU, ARM, AIC preferred

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