We’re committed to putting people first – if you need an accommodation as you go through the job searching, application, and interviewing process, please click here for more information.
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Strong analytical and problem-solving skills with an ability to work with ambiguous and incomplete information. Good understanding of agile software development concepts and processes including backlog tracking, prioritization, strong collaboration within a scrum team, and adaptability through incremental delivery. Must be proactive, demonstrate initiative and be a logical thinker, have extensive consultative skills, including the ability to understand and apply customer requirements, including drawing out unforeseen implications and making recommendations for design, the ability to define design reasoning, understanding potential impacts of design requirements. Strong negotiation, facilitation, and consensus building skills. Experience providing production support including troubleshooting issues, requirements gathering and solution design for enhancement requests, as well as implementing the solution via configuration, etc. Experience within the Insurance or Finance industry is preferred. 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Conduct investigation to secure essential facts from injured worker, employer and providers regarding workers' compensations through telephone or written reports. Verifies information from claimants, physicians, and medical providers to assess compensability and/or causal relation of medical treatment, and make evaluations for cases with claim specific on-going medical management. Provides on-going medical case management for assigned claims. Initiates calls to injured worker and medical provider if projected disability exceeds maximum triage model projection or to resolve medical treatment issues as needed. Maintains contact with injured worker, provider and employer to ensure understanding of protocols and claims processing and medical treatment. Continually assesses claim status to determine if problem cases or those exceeding protocols should be referred to Claims Service Team and/or would benefit from, MP RN review or other medical /claims resources. Arranges Independent Medical Exam and Peer Review as necessary. Maintains accurate records and handles administrative responsibilities associated with processing and payment of claims. Records and updates status notes; documents results of contacts, relevant medical reports, and duration information per file posting standards including making appropriate medical information viewable to customers in Electronic Document Management (EDM). Generates form letters following set guidelines (i.e., letters to physicians projecting disability, letters confirming medical treatment and disability and letters outlining expected outcome to employers). Authorizes payment of medical payments and/or medical treatment. Recognizes potential subrogation cases, prepares cases for subrogation and refers these cases to the Subrogation Units. High school diploma plus 1-3 years' of related customer service experience or applicable insurance knowledge. Licensing required in some states. Effective analytical skills required to learn and apply basic policy/contract coverage and recognize questionable coverage/contract situations (which necessitate supervisory involvement) along with effective interpersonal skills to explain the facts and logic used to arrive at decisions in a way that the customer understands. Effective written skills to compose clear, succinct descriptions when posting files and drafting correspondence. Good telephone and typing skills required. 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Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. Performs other duties as assigned. Bodily injury experience is required. BS/BA degree or equivalent work experience. Minimum of 2 years experience in claims adjustment, general insurance or formal claims training. Required to obtain and maintain all applicable licenses. Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU). 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Interacts independently with field underwriters and directly with UW managers on all mandatory referral cases and voluntary consultation items. Ensures continuity and alignment between Primary and Excess Casualty placements. Supports Executive Underwriting Officer on transactions and serves as trusted advisor in the areas of exposure, coverage analysis, and key pricing/financial elements within their authority. Monitors frameworks for underwriting decisions (e.g., referrals, technical reviews) and recommends improvements, as needed. Evaluates portfolio performance regularly in Majors Risk Management, working with Underwriting Leaders to identify drivers of performance, risks, and opportunities. Drives UW technical excellence across Majors Risk Management, working with Underwriting Leaders to identify and resolve issues. Works with Underwriting Leaders to identify product and services enhancements, underwriter capability development opportunities (e.g., skills, tools), and elevates to Executive Underwriting Officer and Majors Chief Underwriting Officer. Models effective collaboration within/across teams, stakeholders and partners (e.g., UW Support, Claims, Actuarial, NA Product Teams). Expert-level knowledge of all aspects of coverage forms, exclusions, and exposure. Pricing, structure, rating, rating plans, loss forecasting, credit risk, market knowledge, preferred. Experience and working knowledge of Alternative Risk Transfer solutions, preferred. Advanced knowledge of and experience operating within several different industry segments experience with and knowledge of Risk Management programs key; insurance operations; claims, finance and actuarial concepts; regulatory environment; loss control/risk engineering; reinsurance; account management; product development; and industry trends. Must be a skilled collaborator who is willing to assess all sides of an issue, bring in others with expertise, and independently execute and advance the collaboration model. Other professional skills required include superior communication skills (written, verbal, presentation, listening); approachability; tact; coaching/development; analyzing and problem solving; relationship and service driven; clear solutions orientation and commitment to achieving segment operational and financial objectives; negotiation skills; and demonstrated ability to consistently and positively influence others both internally and externally (brokers/customers) as required. 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Developing, evolving, and driving our line of business strategy for core lines of business. Manage multiple Business Lines form and contract initiatives. Analyze information from various resources to develop recommendations. Collaborate with the Product Filings team on achieving approval of filings from regulatory authorities. Inclusive. You seek and value all voices. You embrace diversity and inclusion, and encourage everyone to bring their authentic selves to work. Resilient. You can encounter difficult situations and navigate through them with courage. You are agile and thrive in a quick-paced and ever-changing industry. Curious. You have a desire to dig more deeply, challenge assumptions and solve problems. You adopt a growth mindset and seek to continuously learn and improve. Driven. You set high standards and make things better. You take risks to innovate across products, lines, and processes. You are motivated and proactively volunteer for new challenges. Humble. 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(max-width:989px){#advanced_menu_toggle[data-av_icon]:before{font-size:30px;font-weight:normal;font-family:'FontAwesome'!important;} #advanced_menu_toggle{border-width:0px;} .container{padding:0 30px;} .responsive .logo{padding-top:10px;} } .main_menu .current_page_item a .avia-menu-text{border-bottom:0!important;} @media screen and (max-width:767px){.rem-arrow a:before{content:' '!important;} .responsive #top #wrap_all .container{width:92%;max-width:92%;} #advanced_menu_toggle{left:0;right:auto;border-width:0px;} .responsive #top .logo{margin:0 auto;width:150px;} .responsive .logo img{max-height:40px;margin:0 auto!important;} #header_main{border-top:0;} } @media screen and (min-width:1024px){li#menu-item-13649 ul.sub-menu{left:207px!important;} li#menu-item-13649.dropdown_ul_available>a::after{font-family:FontAwesome;position:absolute;left:auto;margin:0 5px;font-size:10px;} } #top a:focus{outline-offset:-2px!important;opacity:1!important;} .inner-container 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background-color 300ms linear;transition: background-color 300ms linear;} #menu-item-11981:hover{background-color:rgba(255, 255, 255, 0.8) !important;-webkit-transition: background-color 300ms linear;-ms-transition: background-color 300ms linear;transition: background-color 300ms linear;} #menu-item-1136:hover{background-color:rgba(255, 255, 255, 0.8) !important;-webkit-transition: background-color 300ms linear;-ms-transition: background-color 300ms linear;transition: background-color 300ms linear;} #menu-item-1435:hover{background-color:rgba(255, 255, 255, 0.8) !important;-webkit-transition: background-color 300ms linear;-ms-transition: background-color 300ms linear;transition: background-color 300ms linear;} #menu-item-3937:hover{background-color:rgba(255, 255, 255, 0.8) !important;-webkit-transition: background-color 300ms linear;-ms-transition: background-color 300ms linear;transition: background-color 300ms linear;} #menu-item-12966:hover{background-color:rgba(255, 255, 255, 0.8) !important;-webkit-transition: background-color 300ms linear;-ms-transition: background-color 300ms linear;transition: background-color 300ms linear;} .fa-brands{-webkit-font-smoothing: antialiased; font-style: normal; font-variant: normal; line-height: 1; text-rendering: auto;font-family: 'Font Awesome 6 Brands'} .position-details li{list-style-type: disc;} .header-wrapper{display:none!important;}.disability p {text-align:center!important;background-color:#F0F0F0!important; height:45px!important;padding-top:12px!important;} .disability a {color:blue!important;text-decoration:underline!important;} @media only screen and (max-width: 1325px){.disability p {height:67px!important;}} @media only screen and (max-width: 675px){.disability p {height:92px!important;}} @media only screen and (max-width: 480px){.disability p {height:114px!important;}}h4{margin-top: 5px;font-weight: 600;}