Liability Claim Representative/Adjuster/Examiner (Remote) to handle Workers' Compensation Subrogatio
AF Group

Job Info

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Responsible for the proactive management of worker's compensation subrogation claims.

Subrogation Claim Representative II

This is the intermediate level of the subrogation claim representative career path. Manages moderate to difficult claims. Exercises progressively more discretion in the determination of liability. Negotiates and settles with claimants, other insurance companies, and attorneys, within authority, at earliest possible point to bring cases to final resolution.

RESPONSIBILITIES/TASKS:

• Investigates, analyzes, determines potential liability, and effectively settles with adverse parties.
• Completes other duties and special projects as requested.
• Recommends, plans and advocates a position on workers compensation subrogation claims assigned.
• Develops and manages subrogation claim action plans to resolution, coordinates claim processes and approves claim payments.
• Supports the team by acting as back up to Subrogation Representatives.
• Updates databases and prepares reports utilizing standard software.
• Communicates and collaborates with workers compensation claims handlers.
• Negotiates and settles claims within authority, at the earliest possible point to bring cases to final disposition.
• Exercises sufficient and independent judgment to settle cases prior to mediation and/or litigation.
• Obtains all necessary documentation from the appropriate parties within established timelines.
• Properly assesses the cause of action, collectible damages, and liability and expense exposures.
• Composes correspondence and various reports in the management of subrogation claims.
• Responsible for final disposition of the claim including the use of arbitration or litigation.
• Remains abreast of new case law and statutes affecting subrogation.
• Maintains confidentiality of information processed.
• Works closely with manager or Senior Subrogation Claim Representatives on complex files or files above authority
• May work with Claims in participating in agent/client relationship management

Additional Responsibilities/Tasks for SUBROGATION CLAIM REPRESENTATIVE II:

• Manages the administration of complex claims and catastrophic exposures, within authority, including claims generated from dedicated large accounts with guidance from experienced team members.
• Assists in the development of reporting, analysis and may assist with education & training programs as it relates to subrogation.
• Assists in the mentoring of other team members.
• Represents the subrogation team on various committees and projects.
• Directs claims administration efforts within statutory, procedural, case law, contractual and/or philosophical guidelines.
• Provides input regarding case law understanding for subrogation team.
• Assists in mentoring team members

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor'sdegree in insurance, business or a related field. Progress towards, or completion of, industry-recognized professional designation preferred. Combination of relevant education and experience may be considered in lieu of degree. Continuous learning required, as defined by the company's learning philosophy. Certification, or progress toward, highly preferred and encouraged.

Subrogation Claim Representative II:

Three years of experience in a workers' compensation subrogation or subrogation claims environment with demonstrated knowledge of subrogation, or in a claims environment handling liability claims. Experience handling claims in multiple jurisdictions preferred.

OR

Minimum of one year of AF Group Subrogation Representative I experience that includes exposure to difficult or complex subrogation claims.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Knowledge of subrogation process.
• Knowledge of basic medical and legal terminology.
• Effective oral and written communication skills with the ability to effectively communicate with providers, attorneys, agents and policyholders.
• Ability to function effectively in a multi-functional team environment.
• Ability to manage multiple priorities and adapt to changing workflow to still meet deadlines and goals are essential.
• Ability to collect and analyze relevant information and based on the analysis make efficient and effective decisions.
• Excellent customer service and organizational skills are essential.
• Ability to function effectively in a team environment.
• Ability to establish and maintain effective working and client relationships.
• Ability to negotiate with opposing parties and to resolve conflicts in a professional manner.
• Ability to maintain confidentiality as appropriate.
• Ability to research workers compensation and subrogation laws, regulations or specific issues.
• Ability to understand periodic reports.

Additional (SKA) Required for SUBROGATION CLAIM REPRESENTATIVE II:

• Excellent oral and written communication skills with the ability to effectively communicate with providers, attorneys, agents and policyholders. Ability to function effectively in a multi-functional team environment.
• Advanced knowledge of medical and legal terminology.
• Ability to assist in training and mentoring of others.
• Knowledge of the applicability of relevant laws and regulations.
• Knowledge of the appropriate laws, regulatory authorities, industry trends and their impact.
• Ability to make independent decisions.
• Ability to solve complex problems.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Minimal travel. Must possess a valid driver's license with a record that meets corporate standards.

The qualifications listed above are intended to represent the minimal skills and experience levels associated with performing the duties and responsibilities contained in this position description. The qualifications should not be viewed as absolute standards, but as general guidelines that should be considered with other position-related criteria.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.

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