The Claim Specialist III investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. (Supervisor will determine actual individual authority up to the stated maximum). Conducts training classes (including research and position papers) for less experienced Claim Department Representatives. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.
Principal Duties and Responsibilities:
- Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure. Maintains contact throughout the life of the file as needed.
- Administers the delivery of timely, appropriate and accurate indemnity and medical benefits.
- Evaluates claim exposure, negotiate and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary.
- Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.
- Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling.
- Maintains quality claim files in accordance with appropriate best practices, and other company procedures.
- Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate.
- Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate.
- Serves as a mentor and helps prepare/train the less experienced Claim Department representatives.
- Keeps up-to-date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same.
- Prepares and presents files for Agent/Broker Reviews and Insured File Review.
- Understands medical terminology and standard medical procedures as they pertain to worker’s compensation, U.S. Longshoreman’s and Jones Act claims.
- Participates in in-house and outside training programs to keep up-to-date on relevant issues/topics.
- Maintains a working knowledge of all computer systems currently in use.
- Continues education in claims through Associate in Claims or Claims Law (AEI) courses.
Requirements:
- Three years of workers’ compensation lost time claim handling experience required.
- Bachelor's degree preferred.
- Computer skills, Word, Excel and Image Right preferred.
- Must have valid driver’s license.
- Strong attention to detail and strong communication skills both verbal and written.
- Adaptable/flexible and self-directed with the ability to manage time and other resources wisely.
- Must have the ability to work effectively with other organizational team members.
Our comprehensive benefits package includes all traditional offerings such as:
- Health Insurance options, Dental Insurance options and Vision Insurance
- Employee Life Insurance/AD&D and Dependent Life Insurance options
- Short-term & Long-term Disability
- Health Savings Account with potential employer match
- Flexible Medical and Dependent Care Account
- Accident Insurance
- Critical Illness Insurance
- Employee Assistance Program
- Legal/Identify Theft Insurance options
- Long Term Care Insurance
- Pet Insurance
- 401 (k) Retirement Plan with match up to 5%, plus profit sharing & discretionary contributions (subject to vesting)
- 5 weeks of Paid Time Off (PTO)
- 11 paid holidays
We also offer other benefits to help foster a healthy, balance lifestyle such as:
- Flextime schedules
- Paid Parental Leave
- Student loan paydown and refinancing assistance
- Educational assistance for job related courses, seminars, certifications or degrees
- One paid day every year to volunteer for your non-profit of choice
- On-site fitness center (Maine only) or fitness reimbursement
- Subsidized parking
- Sit-Stand desks & daily stretch breaks
MEMIC is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, ancestry, age, disability, genetics, gender identity, veteran's status, sexual orientation, or any other characteristic protected by law.
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