Workman's Compensation Claims Manager - Dallas, United States - The Ladders
Description
We are currently seeking a skilled professional to adjust workers' compensation claims for our programs and captives, reporting to our Dallas, Texas office.(Remote or Hybrid as well). MUST HAVE CALIFORNIA EXPERIENCE AND BE LICENSED AS A CLAIM'S ADJUSTER IN CALIFORNIA OR MAINTAIN A SIP DESIGNATION.
We would prefer an energetic individual who wants to continue their overall development in the insurance industry. We thrive on our passion to be ranked a Best Places to Work by our most important asset, our employees. As we continue to scale, we are seeking a talented Insurance Underwriter to work on our construction group as a Workers' Compensation Compensation.
Primary lines of business that we handle in the captive are Auto, General Liability and Worker's Compensation. The company offers market leading access to all major insurance markets in the US, UK and Canada, as well as exclusive programs and in-house binding authority for property & casualty, financial lines, personal lines, life insurance, medical stop loss risks, travel/accident and health, affinity business and warranty coverage.
We serve commercial companies, non-profits, public entities, associations, unions and individual risks. With offices over 50 locations throughout the US and Canada, and more 1,600 employees. Recognized as one of the top program managers in the country, providing agents, brokers, and self-insured entities with captive and alternative risk solutions. We are at the forefront of the development and management of captives and alternative risk programs.
PRIMARY PURPOSE: Investigate, evaluate and resolve workers compensation claims within authority. Includes the investigation and evaluation of compensability, medical and lost time claims, and the setting of proper reserves in accordance with authority, and Best Practices. The ideal candidate will have proven experience and be self-sufficient in their ability to manage complex workers compensation claims including thorough investigation with injured workers, insureds, medical providers, and witnesses. The candidate will be responsible for all aspects of their claims to ensure correct compensability, reserving, and resolution is realized through individual direction and vendor usage, while adhering to company Best Practices and carrier guidelines.
Essential Functions and Responsibilities:
Exercises proper judgment and decision making to investigate and analyze claim injuries and exposures, determine the compensability, proper course of action and resolution of each claim.
Oversee the handling of all aspects of the claims assigned within authority, including investigation, reserving, documentation, evaluation, medical management, negotiation and settlement.
Experience and skills to manage complex litigation, compensability, and medical issues.
Work with clients and carrier partners in a team approach to achieve best possible outcomes within authority and reporting requirements.
Establish claim reserves based on the most likely outcome of a claim with the known facts and investigation utilizing company standards and experience.
Utilize all available medical management tools and partners to ensure each injured worker attains the best possible outcome through authorization of appropriate treatment plans and accurate billing.
Partner with internal and external legal counsel on litigated or questionable cases. Build strong relationships while ensuring sound legal plans are executed within jurisdictional requirements and financial accountability.
Proactively handle claims with consistent documentation and execution of agreed- upon action plans and strategy.
Demonstrate critical thinking and decision-making skills, to oversee, manage and direct claim processes in a fast-paced environment, while maintaining effective and professional relationships with all stakeholders.
Meet claim handling quality and service standards with timely reporting and presentation of claims to clients, carriers and reinsurers.
Other tasks as assigned by claims management.
Qualifications:
Minimum experience of 7 years with ideal candidate having 10 or more years of experience in the management of workers compensation claims for the states required by the position.
Self-starter and the ability to work independently consistent with experience level, with little supervision and direction.
Thorough understanding of state laws, principles of compensability, medical and insurance industry in general.
Proven ability to build lasting inter-personal relationships and develop credibility with clients, brokers and carriers based on technical claim knowledge.
Strong claim investigative skills and the ability to present the findings and conclusions effectively to others both verbally and in writing.
Valid adjusters license in multiple states, Texas as a preferred home state. If the position handles California claims, the candidate must have current California claims adjuster post-designation training form.
We offer a comprehensive compensation, performance bonus and benefits package. Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future. We are an equal opportunity employer, which complies with all applicable federal, state, and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other category protected by applicable federal, state, or local laws. No phone calls or agencies please.
Prior to a formal employment offer all candidates will be subjected to a thorough background check. Including social media accounts, and criminal background.
NO AGENCIES OR PHONE CALLS PLEASE