Workers' Compensation Claims Specialist OR Senior Specialist – Public Risk Innovation, Solution[...]

AGRiP (Association of Governmental Risk Pools); Atlanta (GA); On-site; USD 70,000 - 110,000; Full time

Job summary

Public Risk Innovation, Solutions, and Management (PRISM) is seeking a Workers' Compensation Claims Specialist. The role may be filled at Specialist or Senior Specialist level based on qualifications.

The position manages a caseload of excess workers' compensation claims, including complex and catastrophic matters, and provides oversight of TPAs and claims processes across PWC and EWC programs, reviewing medical care, reserves, and resolution strategies.

Qualifications

• Experience handling complex/excess workers' compensation claims.
• Ability to oversee TPAs and claims processes.
• Knowledge of medical management, reserves, and reinsurance in WC claims.

Responsibilities

• Manage a caseload of excess WC claims, including future medical and indemnity aspects.
• Provide oversight of TPAs and claims processes across WC programs.
• Review claims for appropriate medical care, reserves, reimbursement, and resolution.

Job description

Public Risk Innovation, Solutions, and Management (PRISM) is seeking a Workers' Compensation Claims Specialist. This position may be filled at the Specialist or Sr. Specialist level, depending on the selected candidates' qualifications.

The Workers' Compensation Specialist/Senior Workers' Compensation Specialist is responsible for managing a caseload of excess workers' compensation claims, consisting of complex and catastrophic claims (future medical and possibly indemnity claims at the Specialist level) along with providing oversight of TPAs and claims processes in both our Primary Workers' Compensation (PWC) and Excess Workers' Compensation (EWC) Programs; reviewing and overseeing claims for appropriate medical care, reserves, reimbursement, reinsurance and resolution.

PRISM is a joint powers authority (JPA) that provides risk management and coverage programs for over 2,000 public entities throughout California. Our organization is member driven meaning that our members have numerous opportunities available to participate in the governance of our JPA.