Claims Specialist, Workers Compensation - West Region

Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages.

Determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners. Refers to claim to subrogation group or Special Investigations Unit as appropriate. Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.

Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution; attends trials as a representative of the company. Acts as senior technical professional on team, assisting team members with escalated issues.

Mentors and trains new team members. Participates in Quality Review process. Participates in conducting Suit Committees, Roundtables, Arbitrations, Mediations, field investigations and may assist in conducting closed file reviews. Performs other duties as assigned. BS/BA degree or equivalent work experience. Minimum of 2 years experience in claims adjustment, general insurance or formal claims training.

Required to obtain and maintain all applicable licenses. Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU). Knowledge of claims investigation techniques, medical terminology and legal aspects of claims.