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Acadia Insurance (a Berkley Company) · 3 hours ago

Senior Claims Representative

US-VA-Manassas

Full-time

Onsite

Mid, Senior Level

3+ years exp

Acadia Insurance, a Berkley Company, is an innovative workers compensation insurance provider focused on making business processes efficient. The Senior Claims Representative will investigate and manage workers’ compensation claims, ensuring timely resolution and compliance with regulatory requirements.

Commercial InsuranceInsurance

Responsibilities

Investigate workers’ compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due

Calculate and set timely financial reserves and proactively manage reserve adequacy throughout claim lifecycle

Record and code injured worker demographics, job information and accident information in company’s claims management system and files necessary forms with state regulatory agencies

Issue timely payments to injured workers, medical providers and service vendors

Coordinate and actively manage medical treatment of injured workers to ensure timely rehabilitation

Negotiate settlements of claims within designated authority with injured workers and attorneys

Serve as the team’s subject matter expert of the Workers’ Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictions

Identify and manage subrogation, Second Injury Fund and joint coverage recovery opportunities

Regularly communicate claim activity and status updates to policyholders, injured workers and other interested parties in a professional, thoughtful and tactful manner

Notify management and develop reports for large exposure claims and comply with reinsurance reporting requirements

Manage the claims litigation process to ensure timely and cost-effective claims resolution

Monitor the expenses and effectiveness of managed care and investigation vendors

Periodically travel to attend hearings, conferences and training sessions

Attend and participate in claim file reviews with management and defense attorneys

Coordinate and lead special projects or processes as assigned by management

Assists with oversight and supervisory duties when the team supervisor is unavailable or as assigned by supervisor

Support management with training and staff development

Support management with vendor management activities

Continuously strives to improve our product and business results through innovation

Obtain and maintain adjuster license(s) in assigned jurisdictions

Qualification

Workers' Compensation ClaimsClaims Management SystemAdjuster LicenseAIC CertificationARM CertificationCPCU CertificationAnalytical SkillsCommunicationInterpersonal SkillsTime ManagementProblem SolvingConflict ManagementDetail Oriented