Major Case WC Claims Specialist

Major Case WC Claims Specialist

Requirements

• Minimum of 5+ years of P&C- Workers Compensation claim industry experience required
• Strong technical understanding of Workers Compensation statutes and case law required
• Jurisdictional knowledge and experience required (Western)
• Ability to be coached, guided and mentored as you develop strategies on larger complex workers compensation claims
• Established ability to execute including a proven track record managing complex projects and initiatives
• Strong analytical ability
• Bias for action and continuous improvement
• Effective communication, interpersonal and negotiation skills
• Ability to influence and communicate across multiple levels of the organization
• Satisfactory completion of the candidate testing/certification process
• Ability to use computer technology to efficiently perform job functions
• Knowledge and experience using basic software program
• State required certification exams and adjusting licenses as jurisdiction requires

Responsibilities

• The MCU Claim Specialist will handle claims in the Western United States including CA, AZ, CO, NM, UT, NV
• Maintain current knowledge of claim loss cost containment initiatives, and use them appropriately and consistently with company practices and procedures to manage assigned claims
• Identify and initiate mitigation, subrogation and other recovery opportunities on assigned claims
• Maintain high standards and a clear understanding of goals for self
• Maintain action-oriented, confident approach to work assignments
• Use critical thinking skills to gather information, apply sound reasoning, draw appropriate conclusions and make sound decisions based on a mixture of analysis, experience and judgment
• Stay current on issues impacting Workers’ Compensation including industry and marketplace trends, strategic direction of the organization, organizational structure and leadership, team goals and internal initiatives
• Identify fraud indicators and initiate investigation on assigned claims
• Demonstrate technical and jurisdictional expertise
• Monitor financial results, trending and variances and identify, implement and manage appropriate adjustments
• Communicate orally and in writing in a clear succinct manner
• Possess superior analytical and critical thinking skills; expert knowledge of complex medical terms, excellent time management abilities
• Properly apply statutory laws and regulations of applicable jurisdiction
• Manage the completion and execution of the investigation, litigation, disposition and settlement of specialized claims, in compliance with corporate claim standards and procedures, and statutory, regulatory and ethics requirements
• Accurately and timely assess the indemnity, medical and expense exposure of assigned Specialized claims and manage the accurate and timely setting of reserves
• Use organizational and communication skills to effectively manage the resolution of assigned claims, manage claim deadlines, and use resources appropriately
• Use claim functional knowledge to appropriately interpret and apply insurance coverage
• Accurately resolve complex coverage and compensability issues
• Demonstrate advanced expertise to use case management practices to effectively reduce loss costs
• Manage claims consistent with our Knowledge Management Tool, Claims Excellence Standards and Performance Improvement goals
• Effectively hold self-accountable for achievement of business results
• Evaluate, acknowledge and manage individual performance through the use of appraisal tools
• Effectively address and manage performance that does not meet required standards
• Mentor and share jurisdictional and technical knowledge with peers, as needed, in order to build capabilities within the supported field claim offices
• Maintain dedication to meeting expectations and requirements of internal and external customers
• Obtain first-hand customer information and use it for improvements in products and services
• Establish and maintain effective relationships with customers, gaining their trust and respect
• Demonstrate diplomacy and tact to effectively avoid or diffuse high-tension situations
• Negotiate skillfully in tough situations with internal and external groups
• Set aggressive and realistic expectations for responding and follow through on commitment. Always demonstrate professionalism and establish credibility when interacting with customers
• Personally enhance The Hartford’s reputation in the marketplace
• Treat all customers with respect and careful attention
• Clearly explain complex or technical information that is helpful to customers
• Contribute to the building of appropriate rapport and constructive and effective relationships with people inside and outside the organization
• Represent The Hartford as a credible, trustworthy, flexible and dependable resource; Demonstrate courtesy, honesty, integrity, respect and competence when interacting with others
• Embrace role and offer advanced expertise to help teammates, solve problems, learn new skills and accomplish goals
• Consistently act with the highest level of integrity and adhere to general principles of business ethics

Preferred Qualifications

• SCLA or CPCU designation preferred
• Bachelor’s degree preferred