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ProAssurance · 1 month ago

Workers' Compensation Senior Claim Representative - Eastern Alliance

Lancaster, PA

Full-time

Hybrid

Senior Level

$65K/yr - $107K/yr

5+ years exp

ProAssurance is an industry-leading specialty insurer specializing in healthcare professional liability, products liability for medical technology and life sciences, legal professional liability, and workers' compensation insurance. The Workers' Compensation Senior Claim Representative will manage all aspects of assigned claims, ensuring adherence to the company's Return to Wellness philosophy and achieving favorable outcomes for injured workers and insureds.

FinanceInsuranceMedical

Responsibilities

Complete ongoing claim management activities proactively and with a sense of urgency in accordance with the ecovery® Return to Wellness philosophy to execute the established plan of action and achieve favorable outcomes for all parties. Maintain, cultivate, and develop high quality, collaborative working relationships with all parties, including injured workers, agents, customers, and co-workers. Maintain regular contact by telephone and correspondence with all parties. Seek complete information necessary to manage claims and achieve favorable outcomes. Respond to inquiries in a timely, courteous, and professional manner

Promptly investigate all assigned claims to establish trust and rapport with all parties, accurately assess coverage, determine the nature and extent of the injuries sustained, and reinforce Return to Wellness expectations. Make fair and timely determinations of compensability. Demonstrate empathy, professionalism, integrity, and objectivity at all times. Prepare reports and forms as required by jurisdictional regulations and by the Company’s established procedures. Promptly establish and maintain case reserves that accurately reflect the anticipated financial exposure on each claim; revise reserves promptly based on changes in facts and circumstances. Identify subrogation potential

Prepare claim status reports for customers, agents, underwriters, reinsurers and others as needed; attend point of sale presentations; attend claim review meetings with customers as necessary to serve claims and present reports

Manage Return to Wellness initiatives by working collaboratively with agents, clients, risk managers and underwriters to ensure proper return to work guidelines and procedures are established, followed and achieved

Prepare for and attend monthly large account team meetings; participate in discussions regarding results, profitability, and renewal strategy

Assist with company projects as assigned and continue professional growth and development through the attendance and participation in insurance related events/functions, seminars, classes and conferences

Qualification

Workers' compensation claims managementState laws knowledgeMicrosoft Office proficiencyAdvanced analytical abilityNegotiation skillsEmpathic listeningOrganization skillsAttention to detailProblem-solving skillsEffective communication

Required

A bachelor's degree and a minimum of five years' experience in workers' compensation claims management or a minimum of ten years working in a professional claims capacity in worker's compensation without a degree is required

Comprehensive knowledge of applicable state laws and industry standards

Ability to independently attend insurance and industry/business functions to promote and present a positive image of the Company

Proficiency in Microsoft Office computer applications; ability to learn new computer software applications

Advanced analytical ability to analyze and interpret information and make appropriate decisions regarding claims payments

Excellent organization and time management skills

Excellent negotiation skills

Attention to detail in processing all information, establishing priorities and meeting deadlines

Excellent analytical and problem-solving skills, including formulating logical and objective conclusions

Ability to assess the urgency and importance of a situation and take appropriate action

Empathic listener with the ability to listen and respond to another person in a way that engenders mutual understanding and trust

Ability to communicate effectively and professionally both verbally and in writing with various constituencies and at all levels, both in and outside of the organization, including agency partners, customers, injured workers and providers

Ability to attend insurance and industry/business functions to promote and present a positive image of the Company