Liability Claim Representative/Adjuster/Examiner Level III, Senior I or Senior II (Remote) to handle
AF Group

Job Info

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Responsible for the proactive management of worker's compensation subrogation claims.

Subrogation Claim Representative III

This is the advanced level of the subrogation claim representative career path. May manage larger, more complex and difficult claims. Exercises significant discretion in the determination of liability. Negotiates and settles with claimants, other insurance companies, and attorneys, within authority, at earliest possible point to bring cases to final resolution.

Senior Subrogation Claim Representative I/II

This position serves as technical expert in the subrogation claim representative career path. Under limited supervision, manages subrogation worker's compensation claims with litigation, complex/catastrophic and/or coverage elements. Manages unique cases, where sometimes little precedence has been established. Serves as department leader by developing other employees and may function as acting manager in the absence of department management.

RESPONSIBILITIES/TASKS:

• Independently investigates, analyzes, determines potential liability, and effectively settles with adverse parties.
• Recommends, plans and advocates a position on complex worker's compensation subrogation claims.
• Develops and manages complex subrogation claim action plans to resolution, coordinates claim processes and approves claim payments.
• Supports the team by acting as back-up to other subrogation team members and manager and is manager's or director's proxy when necessary.
• Updates databases and prepares reports utilizing standard software.

• Proactively communicates and collaborates with worker's compensation claims handlers.
• Negotiates and settles claims within authority, at the earliest possible point to bring cases to final disposition.
• Exercises independent judgment to settle cases prior to mediation and/or litigation.

• Obtains all necessary documentation from the appropriate parties within established timelines.
• Properly assesses the cause of action, collectible damages, and liability and expense exposures.
• Composes correspondence and various reports in the management of subrogation claims.
• Remains abreast of new case law and statutes affecting subrogation.
• Maintains confidentiality of information processed.
• Mentor team members on complex files and files above their authority.
• Works with Claims in participating in agent/client relationship management.
• 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 subrogation.
• Represents the subrogation team on various committees and projects.
• Directs claims administration efforts within statutory, procedural, case law, contractual and/or philosophical guidelines.
• Provides leadership regarding case law understanding for subrogation team.
• 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.
• Coordinates special projects on behalf of management, as assigned.
• Provides training sessions for team and/or other business units, as required.

Additional Responsibilities/Tasks for SUBROGATION CLAIM REPRESENTATIVE III:

• Manages the administration of complex claims and catastrophic exposures, within authority, including claims generated from dedicated large accounts with minimal guidance.

• Mentors team members.
• May act as back-up for team manager.
• Coordinates special projects.

Additional Responsibilities for SENIOR SUBROGATION CLAIM REPRESENTATIVE II:

• Leads catastrophic subrogation claims with large claim volume.
• Handles the most unique cases, where little precedence has been established, requiring innovative administration and problem resolution.
• May provide oversight to vendors.
• May take lead role in claim projects or initiatives.
• Conducts audits of claim files.
• Acts as liaison to claim consultants as needed to support enterprise initiatives.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor'sdegree in insurance, business or a related field. Combination of relevant education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Subrogation Claim Representative III :

Five years of experience in a workers' compensation subrogation or subrogation claims environment with demonstrated knowledge of subrogation, or in a claims environment handling liability claims. Experience handling claims in multiple jurisdictions preferred. Progress toward or completion of industry recognized professional designations preferred.

OR

Minimum of two years of AF Group Subrogation Claim Representative II experience that includes exercising significant discretion in the determination of liability of difficult, complex claims and managing such claims to favorable outcomes.

Senior Subrogation Claim Representative I

Seven years of progressively more responsible experience in a workers' compensation subrogation or subrogation claims environment with demonstrated knowledge of subrogation, or in a claims environment handling liability claims, that provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing complex workers' compensation subrogation claims. Experience handling claims in multiple jurisdictions required.

OR

Minimum of two years of AF Group Claims Subrogation Claim Representative III experience that includes independent handling of complex subrogation claims.

Senior Subrogation Claim Representative II:

Ten years of progressively more responsible experience in a workers' compensation subrogation or subrogation claims environment with demonstrated knowledge of subrogation, or in a claims environment handling liability claims, that provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing the most complex workers' compensation subrogation claims. Experience handling claims in multiple jurisdictions required.

OR

Minimum of three years of AF Group Senior Subrogation Claims Representative I experience that includes independent handling of the most complex subrogation claims.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Knowledge of subrogation process.
• Ability to manage multiple priorities and adapt to changing workflow to still meet deadlines and goals are essential.
• Ability to collect and analyze relevant information and based on the analysis make independent and effective decisions.
• Excellent customer service and organizational skills are essential.
• Ability to establish and maintain effective working and client relationships.
• Ability to negotiate with opposing parties and to resolve conflicts in a professional manager.
• Ability to maintain confidentiality as appropriate.
• Excellent oral and written communication skills with the ability to effectively communicate with providers, attorneys, agents, company leadership and policyholders.
• Ability to function effectively in a multi-functional team environment.
• Advanced knowledge of medical and legal terminology.
• Extensive knowledge of the applicability of relevant laws and regulations.
• Extensive knowledge of the appropriate laws, regulatory authorities, industry trends and their impact.
• Ability to understand business needs and conceptualize and implement processes and procedures that support business strategies.
• Demonstrated superior judgment and analytical abilities.
• Ability to prepare periodic reports as requested.
• Ability to research workers compensation and subrogation laws, regulations or specific issues, 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 and superior ability in managing and resolving complex subrogation claims.
• Demonstrated leadership abilities.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Minimal travel. Must possess a valid driver's license with a record that meets corporate standards.

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.

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