Claim Specialist III

CANDIDATES MUST HAVE GA, VA, TN CLAIMS EXPERIENCE The Claim Specialist III investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. (Supervisor will determine actual individual authority up to the stated maximum). Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision. Principal Duties and Responsibilities 1. Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure. Maintains contact throughout the life of the file as needed. 2. Administers the delivery of timely, appropriate and accurate indemnity and medical benefits. 3. Evaluates claim exposure, negotiate and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary. Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.4. Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling. 5. Maintains quality claim files in accordance with appropriate best practices, and other company procedures. 6. Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate. 7. Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate. 8. Serves as a mentor and helps prepare/train the less experienced Claim Department representatives. 9. Keeps up-to-date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same. 10. Prepares