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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing complex workers' compensation claims, including negotiation, reserve management, and compliance with insurance principles and laws. Proficient in analytical skills and effective communication to ensure timely and cost-effective claims resolution.
Highest-signal resume keywords
Claims Management ExperienceNegotiation SkillsInsurance Principles ExpertiseAnalytical SkillsLicensing (TX or IN)
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingReserve CalculationCost Containment TechniquesLitigation ManagementVendor CoordinationBenefit CalculationStatutory FilingsSubrogation ManagementMedical Management PracticesSocial Security and Medicare Procedures
Soft Skills
Excellent CommunicationStrong Organizational SkillsInterpersonal SkillsTeam CollaborationAbility to Handle Multiple Priorities
Tools & Technologies
Microsoft Office
Certifications & Qualifications
Professional Certification in Insurance
Industry Keywords
Workers' CompensationClaims ResolutionInsurance LawsCost ContainmentRecovery Management
About the role
Key responsibilities & impact- Analyze and process complex or technically difficult workers' compensation claims
- Investigate and gather information to determine claim exposure
- Manage claims through action plans toward appropriate and timely resolution
- Negotiate claim settlements within designated authority
- Calculate and assign timely, appropriate reserves and manage reserve adequacy
- Calculate and pay benefits; approve and make timely claim payments and adjustments
- Settle claims within designated authority level
- Prepare necessary state filings within statutory limits
- Manage the litigation process and ensure timely, cost-effective claims resolution
- Coordinate vendor referrals for additional investigation or litigation management
- Apply cost-containment techniques and strategic vendor partnerships
- Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets
Requirements
What you’ll need- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
- Five (5) years of claims management experience or equivalent combination of education and experience required
- Licensing required: TX or IN
- Subject matter expertise in applicable insurance principles and laws, recoveries, offsets and deductions, claim and disability duration, cost containment principles, medical management practices, and Social Security and Medicare application procedures
- Excellent oral and written communication, including presentation skills
- PC literacy, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Good interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Service Expectations
- Ability to handle multiple priorities and meet deadlines
- Ability to work in a hybrid arrangement, two days in office
Benefits
Comp & perks- Flexible work schedule
- Referral incentive program
- Opportunity to work in an agile environment
- Career development and promotional growth opportunities
- Medical, dental, and vision coverage
- 401K on day one
- 401K matching
- Paid time off (PTO)
- Disability insurance
- Life insurance
- Employee assistance program
- Flexible spending or health savings account
- Other additional voluntary benefits
- Hybrid work arrangement