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Claims Analyst
DEPARTMENT: CLAIMS
REPORTS TO: CLAIMS SUPERVISOR
STATUS: FULL-TIME EXEMPT
REQUIREMENTS:
High school diploma required, college degree preferred. 2-5 years relevant claims adjusting experience in the workers' compensation field. Relevant state licensing where required. Willing to train for the right candidate.
JOB SUMMARY:
Independently adjudicates California compensation indemnity claim files that are non-catastrophic in nature, claim exposures up to $100,000 incurred reserves within branch authority and some catastrophic claim handling in accordance with jurisdictional requirements and company claims practices. Conducts timely investigations, including the receipt of telephonic/recorded statements, in-person interviews, contact with insured, employee, physician, attorney, and/or witness. Handles and reviews coverage issues, determines compensability, schedules appropriate exposure, and addresses timely benefit delivery. Performs recognition of 3rd party liability and subrogation handling through recovery. Identifies and reviews the need for medical case/vocational management to a specific loss and directs/manages activity relative to managed care. Interfaces and manages handling with defense attorneys and investigative vendors when presence is required. Requires litigation experience and control to the extent the company can no longer act in the presence of counsel. Manages litigation from initial Arbitration to the Supreme Court level. Provides direct settlement resolution with the injured worker and/or with opposing counsel. Attends hearings on cases of larger exposure and/or when testimony is necessary. Conducts client visits, depending on special handling parameters as defined in claims best practices, account special handling instructions, or at the discretion of the Claims Manager. Completes status reports on claims greater than or equal to $50,000.
SKILL AND ABILITY PROFILE:
This individual will possess good written and communication skills, be a good listener, work independently and stronghold the understanding of human nature and motivation principles. Readily controls/handles problem issues in times of stress, and/or in a climate of conflict or adversity. Adheres to the code of ethical conduct and recognizes the importance of practicing fair claims practice. Must have computer literacy; familiarity with Microsoft Office a plus. Documentation of claim file activities required. Responds quickly to changing business or customer needs.
If interested, please e-mail resume and cover letter with salary requirements to humanresources@midins.com.
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