Senior Claims Representative (Workers' Compensation) at LWCC People Operations

Baton Rouge, Louisiana, United States -

Full Time

Start Date

Immediate

Expiry Date

01 Jun, 26

Salary

0.0

Posted On

03 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Investigation, Claims Evaluation, Case Management, Litigation Management, Return To Work, Settlement, Reserve Setting, Coverage Analysis, Compensability Determination, Subrogation, Second Injury Fund, Cost Containment, Communication, Negotiation, Problem Solving, Time Management

Industry

Insurance

Description

LWCC is a Champion of Louisiana and proud to be headquartered in the state capital, Baton Rouge. As a model private mutual workers’ comp company, we are dedicated to excellence in execution from underwriting to compassionate care of injured workers. We are proud to partner with our agents and together deliver outstanding service to our policyholders and their workers. Louisiana Loyal, a movement we launched and continue to lead to celebrate and elevate Louisiana, drives us in pursuit of our purpose to help Louisiana thrive by bettering our state one business and one worker at a time. LWCC has been consistently recognized by industry leaders and named to the Ward’s 50® group of top-performing insurance companies, supporting our promise to provide safety, security, and stability to businesses in Louisiana. Our company offers an excellent benefits package including health, dental, vision, life and disability insurance; a 401(k) savings plan; educational assistance; and an on-site fitness center. LWCC is an equal opportunity employer and does not discriminate on the basis of race, creed, color, national origin, religion, sex, age, handicap, Vietnam era or disabled veteran status. For more information on LWCC, its services, and its efforts to elevate Louisiana, please visit www.lwcc.com. Overview Investigates, evaluates, and proactively manages assigned claims of variable complexity through final disposition. Investigates coverage and compensability issues. Handles lost time claims to include high IWIS claims, high exposure claims, as well as claims for assigned special accounts. Will have increased reserve and settlement authority limits. Handling of claims to include medical case management, litigation management, return to work and settlement where necessary. Serves as a resource and mentor to members of the department. Uses technology and systems to manage claims, to include document management, utilization review, and pharmacy management. Claims assigned will be handled independently under general direction according to the established policies, procedures, and precedents. Major Areas of Accountability Serve as dedicated claims representative to handle special customer service requirements for assigned accounts. Proactively manage litigated claims with in-house legal or outside counsel with focus on timely resolution and/or settlement. Evaluate and settle all claims with settlement potential within increased authority limits and present claims exceeding authority levels to executive claims committee for resolution of large exposure claims. Responsible for investigating and determining coverage, compensability, and subrogation and second injury fund potential, as well as resolving unique coverage issues where coverage may involve multiple carriers or claims involving employers’ liability exposure. Manage occupational disease claims and any other claims involving extraordinary claim issues, to include high IWIS claims and other high exposure claims. Manage personal caseload effectively to mitigate exposure within controllable claim cost objectives. Develop cost containment strategies for large claims and make recommendations for productive case outcomes. Document claim files in accordance with quality review standards and complete reinsurance reporting on high exposure claims. Approach job in a conscientious, mature fashion demonstrating a sense of responsibility. Exhibit an ethical manner of conduct and keep sensitive information confidential. Demonstrate a willingness to contribute whatever is necessary to get the job done. Investigate larger more complex workers’ compensation claims following sound claims handling techniques in accordance with company claim philosophy and quality assurance standards. Establish and maintain appropriate file reserves with increased authority limits that accurately reflect file exposure in accordance with company file reserving procedures. In addition to continuous communication with injured workers, medical providers, plaintiff attorneys and defense attorneys, also provides an appropriate level of customer service to policyholders and agents and promptly responds to resolve complaints or claim problems. Resource for and mentor to less experienced claims representatives. Provides other job duties as dictated by office circumstances. Personality/Working Style Strong character Alignment with company values, mission, and vision Trustworthy and honest Decisive Curious and persistent Commitment to accountability Passion for innovation Willingness to learn Adaptive to changing (tolerance for ambiguity) Desire to collaborate to achieve corporate goals Strong communicator Effective communication skills Ability to navigate difficult conversations Empathetic listener and open-minded Focus on customer service and stakeholder experience Analytical skills Mathematics/analytical background Investigation skills Negotiation skills Problem solving skills Time management skills Education and Experience Education Bachelor’s degree and four years handling workers’ compensations claims. OR High School Diploma/GED with eight years of insurance claims handling experience, four of which being workers’ compensation claims. Active Louisiana Workers' Compensation Adjuster License required prior to start or obtained within seven (7) business days after start date. Experience Minimum of two years as a Claims Representative strongly preferred CPCU, ARM, AIC preferred About LWCC Our Team Contact

Responsibilities

This role involves investigating, evaluating, and proactively managing assigned workers' compensation claims of variable complexity through final disposition, including handling lost time, high exposure, and special account claims. Responsibilities also include managing medical case management, litigation, return to work, and settlement processes, while serving as a resource and mentor to department members.