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Workers' Compensation Claims Consultant

Workers’ Compensation Claims Consultant! This Workers’ Compensation Claims Consultant Job is with our growing Client! This Client has a long history of providing quality insurance services to special industries including Construction, Energy, and Forest Products. They serve industries throughout the country. This job will help to ensure our Client’s success in Workers’ Compensation Claims management. Salary is $85k to $110k DOE. Open to Remote Candidates. Some travel requirements. Apply now for this excellent Workers’ Compensation Claims Consultant job by following the instructions at the end of this Job description!

Job Summary for Workers’ Compensation Claims Consultant:

Supervise Workers’ Compensation claim file development on assigned claims. This role provides directions, comments, and suggestions on individual claims files to the respective claims manager/supervisors and/or other claims team members. May also include supervising files handled by TPA’s.

Primary Responsibilities for Workers’ Compensation Claims Consultant:

  • Provides input, authority, guidance, and advice on workers’ compensation claim litigation management, reserving and settlements.
  • Participates in conference calls with outside counsel, nurse case managers and claims personnel to help develop a claims specific plan of action.
  • Interprets policy terms and conditions for all lines, the basic principles of tort and contract law, workers compensation laws and procedures, claim reserving as to adequacy and timeliness and in investigating and reporting on claims, including addressing relevant claims and legal issues.
  • Triage new workers’ compensation claims to ensure initial reserves are adequate, determine compensability and verify coverage.
  • Supervises and communicates with respective claims managers/supervisors and/or other claims personnel, including TPA’s, regarding the handling of individual claim files.
  • Supervises and complies with company procedures and guidelines relating to claim handling practices and the application of fair claim practices acts and similar laws and regulations.
  • Travel as needed for claim file reviews, attending mediations, trials, and strategy conferences.
  • Timely and accurately advises management on matters relating to job responsibilities.
  • Travel as necessary to review claim files, meet with claim personnel, discuss significant claim exposures or attend mediation, trial and strategy conferences.
  • Provides guidance and assistance to claims managers/supervisors and/or other claims personnel on claims handling practices and techniques.
  • Work independently or participates with other claims personnel in special assignments as directed by management.
  • Handle workers’ compensation state reporting and timely responds to regulatory inquiries.
  • Perform other duties as assigned.

Qualifications for Workers’ Compensation Claims Consultant:

  • Minimum of 10 years of experience with the following:
    • Workers’ Compensation - claims handling/supervision.
    • Coverage Review - statements, authorizations, retention of qualified counsel and experts.
    • Managed Care and Cost Containment - experience with the appropriate utilization of these services.
    • FROIs & SROIs - Knowledge of state specific requirements for indemnity EDI reporting.
    • Medicare Set Aside Arrangements and CMS Compliance - Proper compliance with Medicare secondary payer statutes and section III reporting.
    • Claims Administration - Workers’ Compensation knowledge of laws, requirements, and procedures for multiple states.
  • Must be service-oriented, with the ability to provide prompt, efficient, and effective claims and customer service.
  • Proven ability to develop and maintain good working relationships with customers and co-workers, both internal and external Prior insurance experience preferred.
  • Ability to clearly, accurately, and effectively communicate, both orally and in written correspondence and both internally and externally, including with our customers, claimants, and members of the public.
  • Excellent time management skills, with the ability to multitask effectively and meet deadlines.
  • Proven ability to complete time-sensitive tasks, sometimes in a rapid manner; ability to work with intense concentration for extended periods of time.
  • Proven negotiation skills.
  • Excellent judgement and decision-making skills.

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