Claims Representative III

Key Risk (a Berkley Company); Meridian (ID); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Base salary $70k–$90k

Annual discretionary bonus

Benefits package

Job summary

Key Risk is seeking a Workers’ Compensation Claims Representative III to analyze and manage complex workers’ compensation claims, including review, investigation, and coverage determinations. You will negotiate settlements, document claims, and uphold fiduciary responsibilities for policyholders in compliance with state statutes.

The role requires 3–5 years’ claims management experience, a strong adjuster knowledge base, and excellent communication skills.

Qualifications

• 3-5 years of workers’ compensation claims management experience.
• Adjuster license strongly desired or ability to obtain license within six months.
• In depth knowledge of workers’ compensation principles and laws, preferably jurisdiction specific.
• Strong written and verbal communication skills.

Responsibilities

• Analyze and process workers’ compensation claims by investigating and gathering information to determine exposure.
• Negotiate settlements up to authority level and make payments.
• Calculate reserves and manage adequacy throughout the life of the claim.
• Approve claim payments and settle within designated authority level.
• Develop action plans and drive claims to timely resolutions.
• Prepare state filings within statutory limits.
• Manage litigation process for cost-effective resolutions.
• Coordinate vendor referrals for investigation and/or litigation management.
• Use cost containment techniques including vendor partnerships to reduce claims costs.
• Communicate with all parties involved and maintain professional relationships.

Skills

Negotiation

Communication

Time management

Organizational skills

Critical thinking

Teamwork

Urgency

Travel readiness

Education

BA/BS Degree

Job description

Company Details

With over 35 years of proven expertise in the workers' compensation industry, Key Risk delivers innovative and responsive solutions that provide our clients the freedom to do what they do best. Offering guaranteed cost options to employers nationwide, Key Risk focuses on delivering products and services within specialized verticals to reduce workers' compensation exposures and deliver industry-leading results.

Company Details

With over 35 years of proven expertise in the workers' compensation industry, Key Risk delivers innovative and responsive solutions that provide our clients the freedom to do what they do best. Offering guaranteed cost options to employers nationwide, Key Risk focuses on delivering products and services within specialized verticals to reduce workers' compensation exposures and deliver industry-leading results. All products and services are distributed through appointed insurance agents and brokers. Key Risk is a member company of W. R. Berkley Corporation, whose insurance company subsidiaries are rated A+ (Superior), Financial Size Category XV by A.M. Best Company and A+ (Strong), by S&P. For further information about Key Risk please visit www.KeyRisk.com.

Responsibilities

The Workers’ Compensation Claims Representative III is responsible for the analysis and management of complex workers’ compensation claims, including reviewing, investigating, and making decisions regarding coverage, compensability, and appropriateness of claims. The position processes and documents claims to ensure compliance with company standards, industry best practices, and legislative provisions, acts in a fiduciary role on behalf of policyholders, negotiates claim settlements, and conducts the handling of claims in the utmost of good faith in compliance with rules, regulations, and state statutes.

• Analyzes and processes workers’ compensation claims by investigating and gathering information to determine the exposure on the claim
• Negotiates settlement of claims up to designated authority level and makes claims payments
• Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim
• Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level
• Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution
• Prepares necessary state filings within statutory limits
• Actively manages the litigation process; ensures timely and cost-effective claims resolution
• Coordinates vendor referrals for additional investigation and/or litigation management
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims
• Frequently communicates with all appropriate parties involved with the claim
• Maintains professional client relationships
• Actively executes appropriate claims activities to ensure consistent delivery of quality claims services

Qualifications

• 3-5 years of workers’ compensation claims management experience
• Adjuster license strongly desired or ability to obtain license within six months
• In depth knowledge of appropriate insurance principles and laws of workers’ compensation, preferably jurisdiction specific
• Strong written and verbal communication skills
• Strong interpersonal, time management and organizational skills
• Strong negotiation skills
• Proven critical thinking skills that demonstrates analysis/judgment and sound decision making with focus on attention to detail
• Ability to perform with a sense of urgency
• Ability to work both independently and within a team environment
• Ability to travel for business purposes, approximately less than 10%

Education Requirement

• BA/BS Degree

Additional Company Details

We do not accept unsolicited resumes from third party recruiting agencies or firms.

The company offers a competitive compensation plan and robust benefits package for full-time regular employees which for this role include:

• Base Salary Range: $70,000-$90,000
• Eligible to participate in annual discretionary bonus.
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.

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.

Additional Requirements

Location and Travel:

• High Point, NC.
• Travel: Approximately less than 10% for business purposes.

Sponsorship Details

Sponsorship not Offered for this Role