Workers' Compensation Senior Claim Representative - Eastern Alliance

ProAssurance; Carmel (IN); Hybrid; USD 66,000 - 109,000; Full time

Job summary

ProAssurance, a leading insurer specializing in workers' compensation, is seeking an experienced claims professional to manage complex claims for large customers. The role emphasizes Return to Wellness, collaboration with agents, and proactive reserves management.

The candidate should have a bachelor’s degree and substantial workers’ compensation experience, with strong negotiation, analytical, and communication skills.

Qualifications

• Bachelor’s degree and five years’ experience in workers’ compensation claims management, or ten years in a professional claims capacity in workers’ compensation without a degree.
• Comprehensive knowledge of applicable state laws and industry standards.
• Proficiency in Microsoft Office; ability to learn new software applications.
• Advanced analytical ability to analyze and interpret information and make appropriate decisions regarding claims payments.

Responsibilities

• Complete ongoing claim management activities proactively and with urgency to execute the Return to Wellness plan and achieve favourable outcomes.
• Investigate assigned claims to establish trust, assess coverage, and determine injury extent; establish accurate reserves.
• Prepare claim status reports for customers, agents, underwriters, and reinsurers as needed.
• Manage Return to Wellness initiatives with agents and risk managers to ensure proper return-to-work guidelines.
• Attend monthly large account meetings and participate in renewal strategy discussions.

Skills

Negotiation skills

Analytical ability

Time management

Communication skills

Empathic listening

Education

Bachelor's degree in a relevant field

Advanced certification in claims management (preferred)

Tools

Microsoft Office

Claims management software

Job description

An exciting opportunity exists to join the ProAssurance family of companies! Our mission is powerful and simple: We protect others. Choosing a place to apply your talents is an important decision for anyone. You have plenty of options. Why choose ProAssurance? At ProAssurance, we sell a pledge, and that pledge is delivered by our team members. We are seeking individuals who value integrity, leadership, relationships, and enthusiasm—and want to build their career with a great company where they can be their authentic self and feel valued, recognized, and rewarded for their contributions. ProAssurance specializes in healthcare professional liability, products liability for medical technology and life sciences, legal professional liability, and workers' compensation insurance. We are an industry-leading specialty insurer, with job opportunities in much of the contiguous United States.

This position supports our workers' compensation line of business, Eastern Alliance, and can be hybrid, reporting to our Carmel IN office location approximately two times per month, or remote in Kentucky. The primary responsibility of this position is to consistently execute the Company’s ecovery® Return to Wellness philosophy and business model that leads to better outcomes for our injured workers and insureds. Responsibilities of this position include managing all aspects of assigned claims, including verifying coverage, investigating, managing, and resolving complex workers’ compensation claims for the Company’s large customers under moderate supervision, following established Company requirements and procedures, and promptly establishing and maintaining accurate reserves with an authority limit of up to $75,000 all in support of the Company’s revenue and profitability objectives and overall business plan.

What you'll do:

• 35% - Complete ongoing claim management activities proactively and with a sense of urgency in accordance with the ecovery® Return to Wellness philosophy to execute the established plan of action and achieve favourable outcomes for all parties. Maintain, cultivate, and develop high quality, collaborative working relationships with all parties, including injured workers, agents, customers, and co-workers. Maintain regular contact by telephone and correspondence with all parties. Seek complete information necessary to manage claims and achieve favourable outcomes. Respond to inquiries in a timely, courteous, and professional manner.
• 25% - Promptly investigate all assigned claims to establish trust and rapport with all parties, accurately assess coverage, determine the nature and extent of the injuries sustained, and reinforce Return to Wellness expectations. Make fair and timely determinations of compensability. Demonstrate empathy, professionalism, integrity, and objectivity at all times. Prepare reports and forms as required by jurisdictional regulations and by the Company’s established procedures. Promptly establish and maintain case reserves that accurately reflect the anticipated financial exposure on each claim; revise reserves promptly based on changes in facts and circumstances. Identify subrogation potential.
• 15% - Prepare claim status reports for customers, agents, underwriters, reinsurers and others as needed; attend point of sale presentations; attend claim review meetings with customers as necessary to serve claims and present reports.
• 15% - Manage Return to Wellness initiatives by working collaboratively with agents, clients, risk managers and underwriters to ensure proper return to work guidelines and procedures are established, followed and achieved.
• 5% - Prepare for and attend monthly large account team meetings; participate in discussions regarding results, profitability and renewal strategy.
• 5% - Assist with company projects as assigned and continue professional growth and development through the attendance and participation in insurance related events/functions, seminars, classes and conferences.

What we’re looking for:

• A bachelor’s degree and a minimum of five years’ experience in workers’ compensation claims management or a minimum of ten years working in a professional claims capacity in worker’s compensation without a degree is required; advanced certification or training is preferred.
• Comprehensive knowledge of applicable state laws and industry standards.
• Ability to independently attend insurance and industry/business functions to promote and present a positive image of the Company.
• Proficiency in Microsoft Office computer applications; ability to learn new computer software applications.
• Advanced analytical ability to analyze and interpret information and make appropriate decisions regarding claims payments.
• Excellent organization and time management skills.
• Excellent negotiation skills.
• Attention to detail in processing all information, establishing priorities and meeting deadlines.
• Excellent analytical and problem-solving skills, including formulating logical and objective conclusions.
• Ability to assess the urgency and importance of a situation and take appropriate action.
• Empathic listener with the ability to listen and respond to another person in a way that engenders mutual understanding and trust.
• Ability to communicate effectively and professionally both verbally and in writing with various constituencies and at all levels, both in and outside of the organization, including agency partners, customers, injured workers and providers.
• Ability to attend insurance and industry/business functions to promote and present a positive image of the Company.

#LI-Hybrid

We are committed to providing a dynamic and inclusive environment where everyone can do their best work and grow personally and professionally. For that reason, we partner with The Predictive Index (PI) – an organization equally committed to improving the working lives of people, to help us hire the best talent by providing additional insight about one’s work style. The position you applied to requires completion of two assessments prior to being scheduled to interview with a hiring manager. A Talent Acquisition team member may review your application and contact you before the assessment is complete. These assessments are Behavioral and Cognitive, and each assessment takes less than 12 minutes to complete. After submitting your application, you will receive two emails from The Predictive Index inviting you to complete each of these assessments (please check your SPAM or Junk email folder if you do not see these emails in your inbox). Note: If you already completed the assessments as part of an application with us, we may have results on file and you may not receive the emails inviting you to take the assessments. If you are moving forward in the process, a Talent Acquisition team member will confirm if we already have your assessment results.

Position Salary Range $66,229.00 - $109,289.00 The salary range displayed represents the entirety of the pay grade for this position. Most candidates will start in the bottom half of the range. Factors that may be used to determine your actual salary include your specific skills, how many years of experience you have, your location and comparison to other team members already in this role.

Build your career with us and enjoy access to a best-in-class benefits program.

ProAssurance's family of companies has a unique and unwavering focus on our team members. We strive to achieve best-in-the-world status by attracting, hiring, and retaining top industry talent. We work together within our integrated family of companies, no matter the line of business, department or location. We ask, listen and respond to what matters most to team members.

We thank you for your interest in career opportunities with ProAssurance!