Claims Representative - Liability Texas jurisdiction/License required

Salary $50k

PRIMARY PURPOSE:
To analyze mid- and higher-level workers compensation or general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
o Manages general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
o Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
o Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
o Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
o Manages subrogation of claims and negotiates settlements.
o Communicates claim action with claimant and client.
o Ensures claim files are properly documented and claims coding is correct.
o May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
o Maintains professional client relationships.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
o Performs other duties as assigned.
o Supports the organization's quality program(s).
o Travels as required.
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred. Licenses as required.
Experience
Three (3) years of claims management experience or successful completion of Claims Representative training required.
Skills & Knowledge
o Knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
o Excellent oral and written communication, including presentation skills
o PC literate, including Microsoft Office products
o Analytical and interpretive skills
o Strong organizational skills
o Good interpersonal skills
o Ability to work in a team environment
o Ability to meet or exceed Service Expectations
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental:
Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical:
Computer keyboarding, travel as required
Auditory/Visual:
Hearing, vision and talking
NOTE:
Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

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