Senior Claim Representative I (REMOTE- California)
AF Group

Santa Ana, California

This job has expired.


This position serves as a technical expert in the claim handler career path. Under limited supervision, handles claims with litigation, complex/catastrophic and/or coverage elements. Handles the most unique cases, where little precedence has been established. May handle the most complex, high touch or labor intensive customers. Serves as a department leader by developing other employees and may function as acting manager in the absence of department management.

RESPONSIBILITIES/TASKS:

Senior Claim Representative I

  • Independently administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
  • Establishes timely and appropriate reserves based on claim profile and anticipated financial exposure.
  • Represents the Company by working closely with customers, agents and brokers to resolve the most complex claim issues.
  • Negotiates settlements with attorneys or injured and exercises independent judgment to settle cases prior to mediation or litigation.
  • Manages outside vendors to ensure cost containment efforts.
  • Establishes and maintains effective working relationships with all internal and external customers.
  • Stays abreast of changes in workers' compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws.
  • Actively participates in agent/client relationship management.
  • Mentors team members.
  • May serve as department leader in the absence of management or act as manager designee.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS

EDUCATION OR EQUIVALENT EXPERIENCE:

Bachelor's degree in a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Senior Claim Representative I:

Seven years of progressively more responsible experience in a workers' compensation claims environment that provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing the most complex workers' compensation claims. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred.

OR

Two years of AF Group Claims Representative III experience that includes independent handling of the most complex claims and/or the most complex, high touch or labor intensive customers.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

Senior Representative I
  • Ability and proficiency in the use of computers and company standard software specific to position.
  • Knowledge of medical and legal terminology related to the work.
  • Knowledge of workers' compensation laws and regulations, including jurisdictional laws.
  • Effective oral and written communication skills.
  • Effective customer service skills.
  • Ability to negotiate, build consensus and resolve conflict.
  • Ability to act as a representative of the Company and establish effective working relationships.
  • Ability to manage multiple priorities and meet established deadlines.
  • Attention to detail and analytical skills.
  • Ability to make independent decisions.
  • Ability to solve highly complex problems.
  • Ability to train and mentor others.
  • Ability to lead others.
WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Minimal travel required.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.


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