Claims Consultant (Workers Compensation)
Full Time
United States
Posted
Job description
CLAIMS CONSULTANT – WORKERS COMPENSATION
Clear Spring Property and Casualty is a leading provider of property and casualty insurance. Our future-forward strategy is rooted in deep industry knowledge and a mastery of emerging technologies. Clear Spring Property and Casualty Company is a subsidiary of Delaware Life Insurance Company and its parent company, Group1001. Our relationship with these organizations has yielded an innovative technology platform that provides smarter risk management solutions for property and casualty insurance brokers. Clear Spring is dedicated to Group1001's mission: making insurance more useful, intuitive and accessible for everyone. We’re confident in our forward-thinking products, and that you’ll love partnering with us.
Job Summary
The Claims Consultant will provide quality investigation and analysis to manage Pennsylvania Workers’ Compensation Claims to proper conclusion. Generally, works independently, handling claims that vary in complexity from inception to end. Manage all aspects of the claim and assign outside parties such as defense counsel, nurse case management, and surveillance when necessary. Provide guidance to Claims Assistant on medical only files. Represent and advance the success of the organization through their relationships with agents and policyholders.
Main Accountabilities
Qualifications
Clear Spring Property and Casualty is a leading provider of property and casualty insurance. Our future-forward strategy is rooted in deep industry knowledge and a mastery of emerging technologies. Clear Spring Property and Casualty Company is a subsidiary of Delaware Life Insurance Company and its parent company, Group1001. Our relationship with these organizations has yielded an innovative technology platform that provides smarter risk management solutions for property and casualty insurance brokers. Clear Spring is dedicated to Group1001's mission: making insurance more useful, intuitive and accessible for everyone. We’re confident in our forward-thinking products, and that you’ll love partnering with us.
Job Summary
The Claims Consultant will provide quality investigation and analysis to manage Pennsylvania Workers’ Compensation Claims to proper conclusion. Generally, works independently, handling claims that vary in complexity from inception to end. Manage all aspects of the claim and assign outside parties such as defense counsel, nurse case management, and surveillance when necessary. Provide guidance to Claims Assistant on medical only files. Represent and advance the success of the organization through their relationships with agents and policyholders.
Main Accountabilities
- Provide exceptional customer service consistent with the philosophy of Lackawanna Insurance Group.
- Conduct complete investigation of losses through appropriate techniques including interviews with all involved parties, documentation/data gathering and securing/preserving evidence. This enables the Claims Consultant to make determinations in accepting or denying compensability of reported claims.
- Review incoming bills and treatment notes for causality.
- Complete any Bureau or other legal documents as appropriate.
- Promptly establish and maintain accurate reserves.
- Verify coverage for policyholders.
- Maintain contact with claimant, insured, and medical provider on lost time files.
- Work with all parties on a claim to mitigate loss.
- Develop strategy and negotiate claims to a timely conclusion, properly applying state compliance and company policies and procedures. Develop a resolution plan (e.g., pay, deny, dispute) based upon analysis of the facts, defenses, compensability, and statutory/case law.
- Determine need for and provide direction to defense counsel, nurse case managers or other technical experts. Pursue subrogation when necessary.
- Provide claims status reports upon request to internal and external authorized parties.
- Complete large loss reports.
- Ensure data submitted is accurate, timely, and in compliance with all requirements.
- Communicate verbally and in writing with stakeholders in an effective and professional manner.
- Other duties as assigned that contribute to the overall productivity and well-being of the company, specifically to the Claims Department.
- Support workflow in a remote capacity, if applicable. The methods may vary based on work location of assigned Claims Consultant.
Qualifications
- Bachelor’s degree required.
- 5+ years’ experience adjusting Workers’ Compensation lost time claims.
- Solid technical knowledge of Workers’ Compensation laws for Pennsylvania.
- Strong verbal and written communication skills.
- Excellent organizational and multi-tasking skills; ability to prioritize workload.
- Ability to think critically and solve problems, including the ability to interpret related documentation.
- Strong negotiation skills leading to best claim outcomes.
- Work independently and exercise sound judgement.
- Proficiency in Microsoft Office required.
- Experience and appropriate licensure to handle claims in other states a plus.
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