Senior Claims Examiner
MaritzCX
Come work at a place where we take pride in creating a workplace environment that values hard work, commitment, and growth.
Job Description:Education:
Associate’s or Bachelor’s degree preferred in Business Administration or similar field of studyActive Texas All Lines Adjuster licenseDemonstrated progress towards or completion of formal insurance industry designations is preferredWork Experiences:
Minimum five (5+) years of claims management experience or equivalent combination of education and experience required including working with workers’ compensation, property and general liability claims preferably in an insurance related or Risk Management industryTexas non-subscription claims experience preferred but not necessaryModerate litigation claims experience (3+ years)Skills:
Ability to engage people effectively and deliver results using strong influence management skillsAbility to consistently apply sound judgment, and operate professionally, effectively and ethically as an individual contributor and member of a teamSuperior interpersonal, written, and verbal communication skills, with the ability to create thorough documentation and interface effectively with individuals at various levelsExcellent time management skills, ability to support multiple projects, and effectively prioritize and manage a large volume of workAbility to remain organized, pay strict attention to detail, and meet critical deadlines within a high volume, fast-paced environmentAnalytical with strong problem-solving abilities and creative resolution skillsStrong technical claims knowledgeMaintain professional and technical knowledge by attending educational workshops and reviewing technical publicationsProficient use of Microsoft Office programs, including Word and ExcelAcceptable level of hearing and vision to perform job dutiesResponsibilities:
Understands and performs domestic and/or international claim programs, policies, and procedures for: reporting, investigation, and analysis; file reserves, resolution/outcome management; and the delivery of claim information.Moderate litigation management including identifying early settlement opportunitiesManage claims and insurance files, including litigated and complex mattersReviews first and third party claims for irregularities, accuracy and completenessManage technically complex workers’ compensation and Texas non-subscription claimsManage technically complex general liability, auto liability and property claimsPartner with external TPA and/or insurance carriers as neededMonitor claim files to ensure that external TPA is managing files appropriately and in accordance with Claim Service Instructions, establishing appropriate reserves, and issuing benefit payments timelyAssist in claims cost controlMay perform design, analysis, and delivery of claim-related informationSecure evidence related to claims (e.g. merchandise, statements, photos and video footage)Conduct management training on the proper handling of work place injuries, submitting incident injury forms and the procedures for substance abuse testing. Maintain strong and collaborative relationships, serving as a strong advocate of new and enhanced solutions or processes throughout the department and organizationLeverage as a backup to management where neededCoordinate substance abuse testing for post-accident, reasonable suspicion, and property damage to include communication of results to appropriate stakeholdersPartner with management on the status of injured team members and estimated return to work dateCoordinate return to work effortsNotify HR and Payroll of team members who have been placed on leave due to a work-related injuryMaintain current on changes in workers’ compensation laws and other claims-related laws, regulations, and information by attending educational workshops and seminarsThis role focuses on operational effectiveness in support of claims management strategiesDevelop a thorough understanding of Academy policies, procedures and safety rulesDuties may change; Team Members may be required to perform other duties as assignedPhysical Requirements & Attendance:
Acceptable level of hearing and vision to perform job dutiesAdhere to company work hours, policies, procedures and rules governing professional staff behaviorFull timeEqual Employment OpportunityAcademy is an Equal Opportunity Employer and does not discriminate with regard to employment opportunities or practices on the basis of race, religion, national origin, sex, age, disability, gender identity, sexual orientation, or any other category protected by law.
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