Workers' Compensation Claim Representative I
Proassurance Corporation

Job Info

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An exciting opportunity exists to join the ProAssurance family of companies!

We are a specialty writer of professional liability, products liability and workers' compensation insurance. With approximately 1000 employees operating in all 50 states, we are well positioned to offer career opportunities to individuals interested in professional growth.

This position is with Eastern Alliance, a best in class workers' compensation provider and member of the ProAssurance family of companies.

Our Claim Representative I will be based in Madison MS or Charlotte NC. Eastern offers its employees the opportunity to work from home up to 3 days per week.

The primary responsibilities of this position include verifying coverage, investigating, managing and resolving claims for the Company's customers under extensive supervision, following established Company and client requirements and procedures, and promptly establishing and maintaining accurate reserves with an authority limit of up to $25,000 all in support of the Company's revenue and profitability objectives and overall business plan.

Essential Functions:

• 35% Maintain contact by telephone and/or correspondence, with all necessary parties in order to achieve the established plan of action in a timely manner
• 20% Investigate all losses promptly as assigned in order to accurately assess coverage, nature and extent of injury/damages sustained, identify subrogation potential and prepare proper reports and forms as required
• 10% Establish and document a proactive strategy to achieve timely resolution of claims, within statutory requirements and Company guidelines
• 10% Maintain appropriate case reserves for each assigned claim in accordance with the Company's reserving philosophy and/ or the customer's reserve guidelines; Review, approves for payment, or deny medical invoices within time frame set by statutory requirements
• 10% Manage return-to-work initiatives by working collaboratively with agents, clients, risk managers and underwriters to ensure proper return to work guidelines and procedures are established, followed and achieved

Secondary Functions:

• 5% Cultivate working relationships with underwriters, agents and clients in order to meet defined objectives and to attract and retain profitable business; attend internal meetings prepared to discuss adverse accounts, solutions for handling these accounts, and other relevant topics
• 5% Prepare claim status reports for customers, agents, underwriters, re-insurers and others as requested
• 5% Assist with Company projects as assigned and continue professional growth and development through the attendance and participation in insurance related events/ functions, seminars, classes and conferences

Qualifications:

• A Bachelor's degree and a minimum of one year experience or a minimum of 3 years experience working in a professional claims capacity in workers' compensation is required; advanced certification or training is preferred
• Basic knowledge of applicable state laws and industry standards
• Ability to attend insurance and industry/business functions to promote and present a positive image of the Company
• Proficiency in Microsoft Office computer applications; ability to learn new computer software applications
• Advanced analytical ability, in order to analyze and interpret information; and make profitable decisions regarding claims payments
• Excellent organization and time management skills
• Basic negotiation skills
• Attention to detail in processing all information, establishing priorities and meeting deadlines
• Solid analytical and problem solving skills, including formulating logical and objective conclusions
• Ability to assess the urgency and importance of a situation and take appropriate action

• Ability to communicate effectively and professionally both verbally and in writing with various constituencies and at all levels; both in and outside of the organization including agency partners, outside customers and clients

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