Claim Specialist III

Position Overview

The Claim Specialist III is responsible for investigating, assessing, negotiating, and settling lost time claims with authority to settle within specified limits. This role involves managing a growing caseload independently and requires prior experience in Pennsylvania workers' compensation claims.

Key Responsibilities

• Engage with insured parties, injured workers, brokers, witnesses, attorneys, and internal stakeholders to collect and relay necessary information to evaluate coverage, liability, and claim facts, maintaining consistent communication throughout the claim's lifecycle.
• Administer timely and accurate indemnity and medical benefits delivery.
• Assess claim exposure, negotiate settlements, and resolve claims, collaborating closely with defense counsel on litigation matters, including participation in mediations, arbitrations, and hearings as needed. Develop and monitor litigation strategies to control costs and ensure efficient resolutions.
• Work directly with insureds and employees via site visits and presentations to promote a collaborative approach to claim management.
• Maintain compliant and high-quality claim files following best practices and company policies.
• Implement Managed Care initiatives, coordinate rehabilitation and medical management, review medical bills, manage correspondence through document systems, and monitor case progress.
• Coordinate with State and Federal Boards and Commissions, establishing and managing claim reserves appropriately.
• Mentor and train less experienced claim representatives, fostering team development.
• Stay current with state laws and company protocols relevant to claim handling, educating injured workers and insured parties accordingly.
• Prepare materials for Agent/Broker file reviews and insured file evaluations.
• Understand medical terminology and procedures related to workers' compensation and maritime claims (U.S. Longshoreman and Jones Act claims).
• Participate in ongoing training programs to remain informed on regulatory and procedural updates.
• Maintain proficiency in company computer systems used for claim management.
• Travel as required within states to manage assigned claims inventory.
• Pursue continuing education in claims management through courses such as Associate in Claims or Claims Law certifications.

Required Skills and Qualifications

• Minimum of three years experience handling lost time and medical-only workers' compensation claims preferred.
• Bachelor's degree preferred.
• Proficiency with computer applications including Word, Excel, and Image Right document management preferred.
• Valid driver's license required.
• Strong attention to detail, and excellent verbal and written communication skills.
• Flexible, self-motivated, capable of managing multiple priorities and resources effectively.
• Ability to collaborate productively within organizational teams.

Benefits and Perks

• Comprehensive health, dental, and vision insurance options.
• Life insurance for employees and dependents, along with AD&D coverage.
• Short-term and long-term disability insurance.
• Health Savings Account with employer contribution options.
• Flexible Spending Accounts for medical and dependent care.
• Accident, critical illness, legal, and identity theft insurance options.
• Employee Assistance Program.
• Long term care and pet insurance options.
• 401(k) retirement plan with up to 6% company match and annual performance bonuses.
• Generous paid time off: 5 weeks PTO and 11 paid holidays annually.
• Flexible work schedules and paid parental leave.
• Student loan assistance and education support for job-related development.
• Annual paid volunteer day and ergonomic workplace enhancements such as sit-stand desks and stretch breaks.

Equal Opportunity Statement

The organization is firmly committed to nondiscrimination and equal opportunity in employment, welcoming applicants regardless of race, color, religion, national origin, age, disability, gender identity, veteran status, sexual orientation, or any legally protected status.