The Workers’ Compensation Claim Specialist, Senior position is responsible for the investigation and adjustment of workers’ compensation assigned claims. This position may be used as an advanced training position for consideration for promotion to a supervisory/management position. The Workers’ Compensation Claim Specialist, Senior is also accountable for the quality of workers’ compensation claim services as perceived by CCMSI clients and within our corporate claim standards.
Essential Duties & Responsibilities:
Investigate, evaluate and adjust workers’ compensation claims in accordance with established claim handling standards and laws.
Establish reserves and/or provide reserve recommendations within established reserve authority levels.
Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated workers’ compensation claims. Negotiate any disputed bills or invoices for resolution.
Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
Assist in the selection, referral and supervision of designated workers’ compensation claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
Assess and monitor subrogation claims for resolution.
Compute disability rates in accordance with state laws.
Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the workers’ compensation claim adjustment process.
Provide notices of qualifying claims to excess/reinsurance carriers.
Handle more complex and involved workers’ compensation claims than intermediate/lower level claims positions with minimum supervision, as requested.
Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
Supervision of all workers’ compensation claim activity for specified accounts.
Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
Performs other duties as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Excellent oral and written communication skills. Initiative to set and achieve performance goals. Good analytic and negotiation skills. Ability to cope with job pressures in a constantly changing environment. Knowledge of all lower level claim position responsibilities. Must be detail oriented and a self-starter with strong organizational abilities. Ability to coordinate and prioritize required. Flexibility, accuracy, initiative and the ability to work with minimum supervision. Discretion and confidentiality required.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
15+ years workers’ compensation claim experience is required.
Bachelor’s Degree is preferred.
Proficient with Microsoft Office programs.
Certificates, Licenses, Registrations
AIC Designation preferred.
About Illinois Public Risk Fund
Illinois Workers' Compensation Intergovernmental Pool