Our client, one of the top insurance groups in the industry, offers outstanding opportunities for professionals interested in workplace safety and health. They offer unparalleled financial strength, stability and “large company” benefits, in addition to an exciting, friendly, “small company” atmosphere.

Due to growth, the company currently has an opening for a Resolution Claims/Lien Professional, The Resolution Claims/Lien Professional manages a caseload of workers compensation indemnity claims that has been resolved via settlement at the WCAB level, but still has unresolved liens and/or contribution issues to address prior to ultimate closure of the file.

ESSENTIAL RESPONSIBILITIES:

• Calculate appropriate reserves for each claim and ensure that reserves are adjusted as needed.
•  Ensure that all benefits are provided in accordance with the law and that the claim as a whole is managed in accordance with all legal requirements including the issuance of appropriate notices and filings.
• Develop and update a plan of action for the successful resolution of each claim.
• Manage each claim to an appropriate and successful resolution.
• Make prompt, sound decisions on issues that arise in claims.
• Ensure that work is performed in accordance with Company standards, training, and supervisory direction.
• Contribute to the achievement of the Resolution Unit’s goals.
  
• Ensure that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve an appropriate and successful resolution of the claim.
• Assign appropriate tasks to a Claims Assistant and ensure they are performed correctly and efficiently.
• Recommend lien and/or contribution settlement at the appropriate time and value, and effectively negotiate the settlement of all liens and/or contribution issues.
• Foster a positive and close working relationship with other Company staff, including the call center, medical management, special investigations, legal, nurse case management, the call center, client services, marketing, and underwriting.
• Communicate effectively with individuals outside the company, including clients, medical providers, lien claimants, co-defendants, and injured workers.
• Make occasional appearances as a representative of the Company at WCAB hearings, Civil Court proceedings, and Arbitration/Mediation as necessary.
  

• Education and Experience: Bachelor's degree from an accredited college or university is preferred; or an equivalent combination of education and experience. Workers Compensation claims handling experience is also preferred, but not required.
• Language Ability: Able to read and interpret complex documents including statutes, regulations, legal opinions, legal letters, medical records, medical bills, medical resource materials, investigation reports, claim notes, and claim data fields. Able to write clear, concise reports accurately conveying complex and nuanced information. Able to write clear, effective correspondence on complex medical and legal points to people from all walks of life.  Able to effectively present information and respond to questions with managers, clients, claimants, attorneys, medical providers, and others. Able to investigate, persuade, and negotiate over the telephone.
• Math Ability: Able to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Able to compute rate, ratio, and percent. Familiar with the time value of money and reducing future streams of payments to a present value. Familiar with the concept of statistical likelihood as the basis for calculating the value of a possible financial outcome.
• Reasoning Ability: Able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Able to deal with problems involving several concrete variables in standardized situations.
• Computer Skills: Knowledge of Microsoft Office software. Able to quickly master proprietary and vended software applications.
• Certificates and Licenses: Licensed to adjust workers’ compensation claims in one or more jurisdictions.
  

Our client values each individual and recognizes that attracting and retaining high quality talent is essential to the success of the company. Their structure minimizes bureaucracy and creates an environment that encourages employees to see the direct effects of their hard work throughout the company. Each division provides hands on training and maintains a small company feel, creating an atmosphere in which 'team players' thrive.

The company offers a very competitive compensation package that includes:
•    Health
•    Dental
•    Vision
•    Life
•    Disability and AD&D
•    Retirement & Savings Plan with 100% employer match up to 5% of salary
•    Education Assistance Reimbursement
•    Paid Vacation and Holiday

If you fit this description, please forward or upload a copy of your resume and state your salary requirements.

Only US Citizens and Permanent Residents will be considered.