Claim Representative II at Emergent Holdings
United States
$56.7k - $94.9k
<p><span style="font-size: 11pt;"><strong>SUMMARY</strong> </span></p><p><span style="font-size: 11pt;">This is the intermediate level of the claim handler career path. Handles moderate to difficult claims. Exercises progressively more discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. </span></p><p> </p><p><span style="font-size: 11pt;"><strong>ESSENTIAL DUTIES AND RESPONSIBILITIES </strong>include the following. Other duties may be assigned.</span></p><ol style="padding-left: 24px;"><li><span style="font-size: 11pt;">Verifies workers’ compensation coverage of employers and injured employees. </span></li><li><span style="font-size: 11pt;">Determines compensability under workers’ compensation by thorough investigation of the claim. </span></li><li><span style="font-size: 11pt;">Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.</span></li><li><span style="font-size: 11pt;">Facilitates return to work for the injured employee.</span></li><li><span style="font-size: 11pt;">Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.</span></li><li><span style="font-size: 11pt;">Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.</span></li><li><span style="font-size: 11pt;">Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury. </span></li><li><span style="font-size: 11pt;">Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.</span></li><li><span style="font-size: 11pt;">Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.</span></li><li><span style="font-size: 11pt;">Works closely with manager on complex files or files above settlement/reserve authority. </span></li><li><span style="font-size: 11pt;">Manages outside vendors to ensure cost containment efforts. </span></li><li><span style="font-size: 11pt;">Establishes and maintains effective working relationships with all internal and external customers. </span></li><li><span style="font-size: 11pt;">Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws.</span></li><li><span style="font-size: 11pt;">Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.</span></li><li><span style="font-size: 11pt;">Exercises independent judgment to settle cases prior to mediation or litigation.</span></li><li><span style="font-size: 11pt;">Actively participates in agent/client relationship management. </span></li><li><span style="font-size: 11pt;">Assists in mentoring team members.</span></li></ol><p> </p><p><span style="font-size: 11pt;"><strong>EDUCATION AND EXPERIENCE</strong></span></p><p><i><span style="font-size: 11pt;">Relevant combination of education and experience may be considered in lieu of degree.</span></i></p><ol style="padding-left: 24px;"><li><span style="font-size: 11pt;">Bachelor’s degree in a related field. Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.</span></li><li><span style="font-size: 11pt;">Three (3) years of experience in a workers’ compensation claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing workers’ compensation claims. Experience of handling claims in multiple jurisdictions preferred. Bilingual skills preferred. </span><ol style="list-style-type: lower-alpha; padding-left: 48px;"><li><span style="font-size: 11pt;">OR</span></li></ol></li><li><span style="font-size: 11pt;">One (1) year of AF Group Claims Representative I experience that includes handling of difficult or complex claims.</span></li></ol><p> </p><p><span style="font-size: 11pt;"><strong>QUALIFICATIONS</strong></span></p><p><span style="font-size: 11pt;">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, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.</span></p><p> </p><p><span style="font-size: 11pt;"><strong>OTHER SKILLS AND ABILITIES</strong></span></p><ol style="padding-left: 24px;"><li><span style="font-size: 11pt;">Ability and proficiency in the use of computers and company standard software specific to position.</span></li><li><span style="font-size: 11pt;">Knowledge of medical and legal terminology related to work.</span></li><li><span style="font-size: 11pt;">Knowledge of workers’ compensation laws and regulations, including jurisdictional laws.</span></li><li><span style="font-size: 11pt;">Effective oral and written communication skills.</span></li><li><span style="font-size: 11pt;">Effective customer service skills.</span></li><li><span style="font-size: 11pt;">Ability to negotiate, build consensus and resolve conflict.</span></li><li><span style="font-size: 11pt;">Ability to manage multiple priorities and meet established deadlines.</span></li><li><span style="font-size: 11pt;">Attention to detail and analytical skills.</span></li><li><span style="font-size: 11pt;">Ability to work independently as well as within a team.</span></li><li><span style="font-size: 11pt;">Ability to make independent decisions.</span></li><li><span style="font-size: 11pt;">Ability to solve complex problems. </span></li></ol><p> </p><p><span style="font-size: 11pt;"><strong>ADDITIONAL INFORMATION </strong></span></p><p><span style="font-size: 11pt;">The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.</span></p><p> </p><p style="background-color: white; margin: 0in;"><span style="color: rgb(51, 51, 51); font-family: Arial, sans-serif;"><span style="font-size: 11pt;"><strong>PAY RANGE:</strong></span></span><br><span style="color: rgb(51, 51, 51); font-family: Arial, sans-serif;"><span style="font-size: 11pt;">Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not the standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $56,700 and $94,900.</span></span></p><p style="background-color: white; margin: 0in;"> </p><p><i><span>We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.</span></i></p><p style="background-color: white; margin: 0in;"> </p><p style="background-color: white; margin: 0in;"><span style="color: rgb(51, 51, 51); font-family: Arial, sans-serif;"><i><span style="font-size: 10pt;">#LI-CD1</span></i></span></p><p style="background-color: white; margin: 0in;"><span style="color: rgb(51, 51, 51); font-family: Arial, sans-serif;"><i><span style="font-size: 10pt;">#AFG</span></i></span></p><p> </p><p> </p>
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