Responsible for ensuring the proactive management of worker’s compensation third party action claims. Exercise significant discretion in the determination of liability of third party claims. Estimate the costs of personal injury, considering such factors as nature of the injury, diagnosis, prognosis, earning capability, and the need for rehabilitation. Negotiates and settles with claimants and/or attorneys, within authority, at earliest possible point to bring cases to final disposition.
Investigates, analyzes, determines liability, and effectively settles with adverse parties to recover third party claims.
Recommends, plans and advocates a position supported by the investigation assessment and final disposition of all Workers Compensation Subrogation Claims assigned.
Properly assesses the cause of action, collectible damages, liability and expense exposures.
Responsible for final disposition of the claim including the use of Arbitration or Litigation.
Communicates and collaborates with all of the operating units, claims examiner/adjusters and various Accident Fund Company personnel.
Develops and manages subrogation claim action plans to resolution, coordinates claim processes and approves claim payments.
Manages the administration of complex claims and catastrophic exposures, within authority, including claims generated from dedicated large accounts.
Assists in the development of reporting, analysis and conducts education & training programs as it relates to liability claims, as needed.
Ensures proficiency in litigation management and third party strategies and recoveries.
Utilizes cost containment programs, tools, and strategies as appropriate.
Directs claims administration efforts within statutory, procedural, case law, contractual and/or philosophical guidelines.
Negotiates and settles claims within authority, at the earliest possible point to bring cases to final disposition. Exercises sufficient and independent judgment to settle cases prior to mediation and/or litigation.
Engages in assisting the mentoring of other team members
Represents the Subrogation Team on various committees and projects
Provides leadership regarding case law understanding for Subrogation Team
Obtains all necessary documentation from the appropriate parties within established timelines.
Completes other duties and special projects as requested.
Additional Senior Subrogation Examiner Responsibilities/Tasks:
Provides guidance and advice when required or necessary and encourage/motivate employees in their daily efforts
Serves as a technical expert for the subrogation team.
Acts as back-up for Team Manager.
Coordinates special projects of behalf of management, as assigned.
Provides training sessions for team and/or other business units, as required.
EDUCATION OR EQUIVALENT EXPERIENCE:
degree in insurance, business or a related field. Progress towards, or completion of, industry-recognized professional designation preferred. Combination of relevant education and experience may be considered in lieu of degree.
Five years experience in an insurance organization including demonstrated technical knowledge in Subrogation Claim handling. Workers compensation insurance administration experience preferred.
Additional Senior Subrogation Examiner Experience:
Seven years experience in an insurance organization including demonstrated technical knowledge in Subrogation Claim handling. Workers compensation insurance administration experience preferred.
Progress toward or completion of industry recognized professional designations preferred. One year working in supervision, or lead role preferred.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Excellent oral and written communication skills with the ability to effectively communicate with providers, attorneys, agents and policyholders
Ability to function effectively in a multi-functional team environment.
Knowledge of the applicability of relevant laws and regulations.
Knowledge of medical and legal terminology.
Ability to assist in training and mentoring of others
Extensive knowledge of appropriate jurisdictional laws, regulatory authorities, industry trends and their impact
Ability to mange multiple priorities and adapt to changing workflow in order to still meet deadlines and goals are essential.
Excellent customer service and organizational skills are essential.
Additional Senior Subrogation Examiner (SKA) Required
Ability to understand business needs and conceptualize and implement processes and procedures that support business strategies.
Demonstrated superior judgment and analytical abilities in evaluating subrogation claims and identifying the proper course of action.
Ability to prepare periodic reports as requested.
Ability to research workers compensation and subrogation laws, regulations or issues specific, in order to offer guidance or direction to others.
Ability to comprehend the consequences of various problem situations and address them.
Ability to take a lead role and/or assist in training and mentoring of others.
Demonstrated expertise regarding subrogation claim handling.
Demonstrated leadership abilities.
Work is performed in an office setting with no unusual hazards. Minimal travel.
The qualifications listed above are intended to represent the minimal skills and experience levels associated with performing the duties and responsibilities contained in this position description. The qualifications should not be viewed as absolute standards, but as general guidelines that should be considered with other position-related criteria.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.
Accident Fund Holdings wants to keep your workplace safe. Founded in 1912, the company is the largest non-governmental specialty writer of...