Senior Claims Adjuster - Midwest regional office (291019-702)

Brickstreet Mutual Insurance Naperville, IL
This position will work full time in the Midwest regional office in Naperville, Illinois.

The Senior Claims Adjuster manages both routine and complex lost-time claims, including those with the potential to become serious and produce excessive costs. The Senior Claims Adjuster is responsible for the investigation, evaluation and determination of liability for work-related injury and disease claims following established guidelines to determine benefit eligibility. The Senior Claims Adjuster assesses expected losses and creates plans to minimize and/or eliminate risk factors in order to achieve effective claims outcomes. The position's objective is to provide superior service in a cost- effective manner by executing best claim practices in an effort to eliminate unwarranted losses. The Senior Claims Adjuster also serves as a resource to Claims Adjusters.

The items listed are essential functions of the position unless otherwise stated

Position Responsibilities:

* Methodically evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims to their most cost- effective conclusion.

* Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision.

* Take recorded statements when necessary.

* Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines.

* Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels.

* Establishes and maintains reserve values within authority limits, which accurately predict the loss reflecting the current known circumstances of the claim.

* Actively develops the investigation of and pursuit of subrogation recoveries when possible.

* Consults with supervisor or technical support staff on unusually complex claims.

* Investigates, evaluates and negotiates settlements, applying technical knowledge and human relation skills to effect fair and prompt claim closure and to contribute to a reduced loss ratio.

* Redirects the claim to the appropriate subject matter expert if the claim becomes significantly complex or presents significantly increasing financial exposure.

* Applies effective protocols for medical management, litigation, fraud/abuse and recovery.

* Effectively manages litigation in conjunction with legal counsel.

* Presents claims and participates in discussion at team staffing.

* Works collaboratively with injured employee, employer, outside counsel, health and rehabilitation professionals to manage the claims costs, promote quality medical care and timely return-to-work to achieve optimal cost-effective medical and vocational outcomes.

* Along with the supervisor, Business Director and other claims staff, assists with or facilitates meetings with policyholders.

* Nonessential function: other duties as assigned.

Required Skills

* Knowledge in best claims practices and laws, court procedures, precedents and government regulations.

* Ability to apply relevant information and individual judgment to determine whether events or processes comply with laws, regulations or standards.

* Ability to recognize and analyze new or changing information that could affect the claims handling strategy and/or potential claims cost, and effectively use the information to manage the claim.

* Demonstrated ability to work effectively in a team environment.

* Demonstrated ability to use logic and sound reasoning to identify alternative solutions for problem-solving.

* Demonstrated understanding of how to apply general rules to specific problems to produce workable solutions.

* Ability to develop specific goals and plans to prioritize, organize, and accomplish work.

* Demonstrated proficiency in evaluating the relative costs and benefits of potential actions to choose the most appropriate one.

* Skilled in the use of computers and claims management systems and other typical business-related programs.

* Demonstrated ability to develop and maintain strong, effective internal and external relationships.

Required Experience

* Bachelor's Degree from an accredited college or university is preferred.

* Must have three years of experience in the insurance, claims investigation, legal, rehabilitation, or medical claims processing. Workers' compensation claims experience preferred.

* Must hold or be eligible to obtain a valid Adjuster's License in applicable states*.

* Must display skills and experience in industry's best practices commensurate with BrickStreet's published Best Practices for Claims Management.

* Must pass the claims adjuster license exam(s) for applicable states within 60 days of being hired.

Applications must be received by 5 PM Friday, June 29, 2018.