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UFG Insurance · 3 days ago

Claims Specialist II - WC

Cedar Rapids, IA

Full-time

Hybrid

Senior Level

$60K/yr - $79K/yr

5+ years exp

UFG Insurance is currently hiring for a Claims Specialist II to work with their Workers Compensation team. This role is primarily responsible for verifying coverages, conducting research on claims, analyzing compensability, and negotiating claims to resolution while promoting a positive work environment and strong service orientation.

Financial ServicesInsurance

Responsibilities

Review claim assignments to timely determine policy coverage, compensability of a claimed injury or illness and facilitation of medical, indemnity and other statutory workers’ compensation benefits. If a coverage issue is relevant, review facts with a designated leader or mentor to determine a proper plan of action

Make prompt, meaningful contact with insureds and their employees to research facts by conducting interviews; securing, understanding and synthesizing information from relevant documents; identifying other relevant parties to a claim; and proactively supporting all parties with their commitment to outcomes

Establish rapport and an outcome focused relationship with insureds and their employees, as well as other internal and external stakeholders, through consistent on-going contact throughout the recovery process and claim resolution

Request and analyze medical records to determine compensability according to evidence-based causation by jurisdiction. Develop knowledge of how to conduct medical and legal research

Interact with medical providers to clearly define medical causation and establish treatment plans focused on recovery

Promptly and supportively inform insured and employees as well as other stakeholders of coverage and compensability decisions

Support stay-at-work or return-to-work opportunities for insureds and their employees. Propose and facilitate vocational support when appropriate by jurisdiction

Identify subrogation potential and document evidence in support of subrogation. Understand the subrogation mechanism and actively partner with internal and external subrogation partners to achieve outcomes with a goal to achieve global resolution

Identify potential Medicare eligibility and comply with all Medicare Secondary Payor requirements of law. Develop knowledge of Medicare settlement obligations

Assess and periodically re-assess the nature and severity of injury or illness. Design a plan of action focused on recovery and resolution in accordance with claims best practice guidelines by jurisdiction. Identify factors which could impact successful outcomes and collaborate with others on plans of action to mitigate impacts

Assess and periodically re-assess claim file reserves adequacy. This will be achieved through understanding medical diagnoses and care plan developments; thorough analysis of wage information and accurate calculations of indemnity benefits; and by securing and providing job descriptions specific to the employee to medical providers. Promptly identify factors of risk for increased loss and expense costs

Execute all technical claim handling functions such as documenting facts within the claims management system in a consistent, concise and clear manner; make timely decisions and promptly communicate decisions to stakeholders; process accurate benefit payments; and seek opportunities to mitigate claim handling expenses

Proactively seek resolution of claims by defining stakeholder outcome expectations early and often, managing processes focused on outcomes and engaging in direct negotiation, mediation, settlement conferences or hearings according to jurisdiction. Emphasis is placed on seeking opportunities to overcome resolution barriers

Comply with statute specific claims handling practices and reporting requirements

Inform underwriting of increased hazards or unusual circumstances concerning a risk/policy exposure

Participate in internal and external continuing education opportunities to maintain licensure and develop claim handling skills and abilities

Demonstrate a supportive attitude and presence within the team by adapting well to change in process or procedure. Share innovative ideas to improve work product and outcomes. Take initiative to identify and learn about areas of professional development. Proactively seek out opportunities to collaborate with peers

Demonstrate interest in one’s own career development and interest in supporting peers with their development

Qualification

Workers' Compensation Claims HandlingMedicalLegal KnowledgeAnalyticalCritical ThinkingWorkers' Recovery Professional CertificationWorkers' Compensation Law Associate CertificationService-Oriented MindsetClearProactive Decision-makingCuriosityConcise CommunicationTime ManagementCollaboration

Required

High school diploma required

Meet the appropriate state licensing requirements to handle claims

Within 1 year of hire, complete the Workers' Recovery Professional (WRP) certification program

Within 3 years of hire, complete the Workers' Compensation Law Associate (WCLA) certification program

3+ years of general work experience

5+ years of workers' compensation claims handling experience or a combination of workers' compensation claims handling experience and experience in a related field

General knowledge of insurance, medical and legal concepts is required with a high degree of ability to articulate knowledge verbally and in writing

Service-Oriented Mindset

Clear and Concise Communication

Analytical and Critical Thinking

Attitude of Collaboration and Curiosity

Proactive Decision-making and Problem-solving

Time management and Sense of Service Urgency

Demonstrate mentorship within the team

Actively demonstrate engagement in executing on claims initiatives