Zenith Insurance Company (United States)

Operations

• Provide strategic and operational leadership for the property claims department
• Direct, control, and monitor coverage, liability, and damage investigations and determinations
• Lead negotiation strategy and resolution of claims within the specialty area
• Provide leadership and technical advice to claims professionals
• Monitor industry data, trends, and new legal issues
• Ensure claims professionals deliver technical and customer service excellence
• Conduct claim file reviews and inspections for quality control and performance evaluation
• Initiate corrective actions as necessary
• Ensure compliance with state and federal laws, regulations, company best practices, corporate values, and communications
• Hire, motivate, coach, retain, train, develop, supervise, and promote associates
• Evaluate performance, prepare appraisals, and recommend salary actions
• Work with defense counsel to expedite claim resolution and manage LAE
• Lead development of initiatives, efficient processes, procedures, and technologies including AI
• Establish best claims practices, policies, procedures, and claims system rules
• Perform other duties as assigned

Director of Property Claims Operations

Claims Specialist

• Investigate, analyze, and determine the extent of the company's liability concerning claims
• Attempt to effect settlements with claimants
• Correspond with or interview medical specialists, agents, witnesses, and claimants to compile information
• Calculate benefit payments and approve claims payments within authorized monetary limits
• Manage assigned claims within published performance standards
• Open new claims, complete three-point contact, and investigate compensability, subrogation, and apportionment
• Set and monitor appropriate reserves throughout the life of each claim
• Follow system documentation procedures to preserve data integrity
• Create and execute action plans to bring cases to closure
• Complete settlement evaluations, recommend settlement values, and negotiate settlements with injured workers and/or attorneys
• Maintain regular contact with injured workers, employers, and agents
• Apply logical thinking to define problems, collect data, establish facts, and draw conclusions
• Perform other duties as assigned

Workers' Comp Claims Specialist

Strategist

• Negotiate directly with providers for the most reasonable reimbursement of medical bills in accordance with the respective jurisdictional rules and regulations
• Use critical-thinking to make decisions affecting the outcome of payments to direct-providers
• Provide consultative recommendations to other departments on disputes, pre-servioce agreements, and settlements based upon negotiations experience and knowledge of successful strategies
• Contract directly with providers and execute legible, effective and concise negotiation agreements
• Ensure negotiations comply with regulatory and company timelines
• Document all negotiation activities and savings
• Develop and preserve effective working relationships with provider communities and billing entities
• Seek, identify and implement process improvements
• Evaluate project plans and change approach when desired outcomes are not being reached
• Understand Workers' Compensation regulations to determine negotiation strategies for fair and reasonable reimbursement
• Coordinate and perform research as required, including provider participation, lien defense, special projects, and A/R research
• Define problems, collect data, establish facts, and draw valid conclusions
• Provide problem solving regarding network information requests
• Evaluate provider trends and collaborate with business functions to achieve negotiated outcomes
• Review and discuss cost drivers and opportunities for further control
• Manage relationships with select trading partners
• Develop direct in-person relationships with providers identified through trend analysis to impact medical cost
• Identify and execute cost containment strategies for all states
• Serve as a local resource of the Provider Relations department for branch offices
• Perform other duties as assigned

Director of Property Claims Operations

Workers' Comp Claims Specialist

Provider Reimbursement Strategist