Workers' Compensation Technical Claim Specialist

Job description

BASIC PURPOSE: In accordance with application of state and federal laws and company best practices and under limited supervision, responsible for the investigation, evaluation, and disposition of complex Workers Compensation cases of high exposure and severity. Gather and review claim information, determine coverage, and conduct investigation. Initiate and maintain customer contact to provide updates and resolve any issues with the claim. Update information in the claim system to document claim handling activities. Determine/set reserves and make payments within level of authority. Applies established medical management strategies in high dollar complex claims. Direct work of defense attorneys. Investigate and refer identified claims to Loss Recovery Services as applicable. Has developed high level of knowledge of Workers Compensation claims handling techniques and is cognizant of new industry trends and claim handling techniques. QUALIFICATIONS: - Perform claim tasks timely and document claim files appropriately. Proactively manage claim activities to ensure fair claim resolution. Handle all claims in accordance with state and federal laws. - Apply advanced expertise in jurisdicti...