Workers Compensation Benefit Management Case Manager

Descripción del puesto:

Who Are We?

Taking care of our customers, our communities and each other. That's the (COMPANY NAME) Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.

Job Category
Claim

Compensation Overview

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

Salary Range
$60,600.00 - $100,100.00

Target Openings
1

What Is the Opportunity?
Under moderate supervision, manage Workers' Compensation claims with: Active Lifetime Indemnity and/or Medical Benefits where the medical expenditures exceed $6,000 annually and there are settlement opportunities. Claims with lifetime medical and the indemnity is capped. Litigation for ongoing benefits/entitlement does not include temporary indemnity benefits.

Experience handling workers compensation claims in Oregon and/or Washington is strongly preferred.

What Will You Do?

* Manage and resolve those claims where pre-injury return to work is unlikely.
* May use structured settlement/annuity as appropriate for the jurisdiction.
* Develop strategies to manage losses involving complex issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.
* Manage litigation to drive files to an optimal outcome, including discontinuation of benefits.
* Manage existing offsets, including apportionment, contribution and subrogation.
* Facilitate timely claim resolution by leveraging any mitigation opportunities.
* Establish and update reserves to reflect claim exposure and document rationale. Includes setting lifetime reserves with the assistance and oversight of MCU.
* Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e., structured settlement, discontinuation of benefits through litigation). Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy.
* Apply knowledge to determine causal relatedness of medical conditions.
* Negotiate settlement of claims within designated authority.
* Proactively manage inventory with documented plans of action to ensure timely and appropriate file closure or reassignment.
* Manage cases telephonically with an emphasis on maximizing quality and controlling costs through aggressive case resolution.
* Review, approve and issue accurate and timely indemnity, medical and expense payments for lifetime/long-term claims.
* Determine Value of Claim.
* Complete required letters and state forms and any other required documents as required.
* Establish and maintain incurreds which reflect the exposure of the claim, and document a clear reserve rationale.
* Apply coverage (limits, endorsements).
* Determine and apply offset/contribution from 3rd party, second injury fund, liens, etc.
* Develop and Execute Resolution Strategy.
* Determine and actively develop ongoing strategic plans for resolution as required and when a significant event impacts the claim.
* Utilize and manage resources as necessary to resolve outstanding issues.
* Communicate and complete denials on medical and indemnity issues.
* Manage inventory to ensure timely file closing or timely reassignment if necessary.
* Settlement Evaluation and Negotiation.
* Evaluate and document a detailed settlement analysis, value and range within settlement authority.
* Execute negotiation strategy and communicate status.
* Identify and evaluate the need for Allocation or Medicare Set Aside and make appropriate referral.
* Customer Engagement.
* Participate in Telephonic and/or onsite File Reviews.
* Respond to inquiries - verbal and written.
* Keeping injured worker apprised of claim status.
* Engage specialty resources as needed.
* May act as technical resource to others.
* In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and (COMPANY NAME) requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
* Maintain Continuing Education requirements as required.
* Other duties as assigned.
* Perform other duties as assigned.

What Will Our Ideal Candidate Have?

* College degree preferred.
* 2+ years Workers Compensation claim handling experience preferred.
* Experience handling workers compensation claims in Oregon and/or Washington is strongly preferred.
* Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.
* Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders.
* Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
* Working Insurance Contract Knowledge: Interprets policies and contracts, applies loss facts to policy conditions, and determines whether or not a loss comes within the scope of the insurance contract.
* Principles of Investigation: Basic investigative skills including the ability to take statements. Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss.
* Value Determination: Intermediate ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.
* Settlement Techniques: Intermediate ability to assess how a claim will be settled, when and when not to make an offer, and what should be included in the settlement offer package.
* Legal Knowledge: General knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
* Medical knowledge: General knowledge of the nature and extent of injuries, periods of disability, and treatment needed. Knowing available medical resources and when to utilize these resources.
* WC Technical:
* Intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state.
* Customer Service:
* Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes
* Teamwork:
* Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result
* Planning & Organizing:
* Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals

What is a Must Have?

* High school diploma or equivalent required.
* Minimum of 1 year Workers Compensation claim handling experience or successful completion of the WC trainee program required.

What Is in It for You?

* Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
* Retirement: (COMPANY NAME) matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, (COMPANY NAME) will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by (COMPANY NAME).
* Paid Time Off: Start your career at (COMPANY NAME) with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
* Wellness Program: The (COMPANY NAME) wellness program is comprised of tools and resources that empower you to achieve your wellness goals. In addition, our Life Balance program provides access to professional counseling services, life coaching and other resources to support your daily life needs. Through Life Balance, you're eligible for five free counseling sessions with a licensed therapist.
* Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. (COMPANY NAME) has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.

What Is in It for You?

* Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
* Retirement: (COMPANY NAME) matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, (COMPANY NAME) will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by (COMPANY NAME).
* Paid Time Off: Start your career at (COMPANY NAME) with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
* Wellness Program: The (COMPANY NAME) wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
* Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. (COMPANY NAME) has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.

Employment Practices

(COMPANY NAME) is an equal opportunity employer. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.

In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.

If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.

(COMPANY NAME) reserves the right to fill this position at a level above or below the level included in this posting.

To learn more about our comprehensive benefit programs please visit http://careers.(COMPANY NAME).com/life-at-(COMPANY NAME)/benefits