Responsibilities
Job Summary: Conducts all necessary investigations in a timely manner on all types of claims and RTW cases to determine the facts and / or activities resulting in expenses related to the reported incident or case.Essential Functions / Process Responsibilities (other duties may be assigned)- Investigating and analyzing all type of claims for work injury, property damage, bodily injury, or liability claims and RTW cases to determine the facts/plan of action to resolve claims and control expense.
- Conducting customer relations and customer services to diffuse situations.
- Conducts investigations on all types of claims and RTW cases and provides recommendation for best course of action- Reviews and interprets existing, new, or proposed OSHA regulations, updates to department staff as necessary- Investigates and documents hazard reviews; analyzes, evaluates, and presents recommendations- Coordinates litigation case management to ensure cost containment; attend trials when needed, reports on trial to management, ensures clear and concise communication between defense attorney and management- Manage incident reports and determine appropriate action plan- Communicates with all partners, customers and other third parties who have filed an incident report to determine an appropriate action plan and to provide the best possible customer service- Reviews and evaluates reports of occupational injuries, determine eligibility, and administers any and all benefits due in accordance with the provisions of the Work Injury Benefit Plan- Facilitates subrogation/recovery efforts from third parties responsible- Coordinates the effective administration of the Return to Work Program- Conducts more intensive investigations for referred cases- Continuously reviews, sets, and monitors reserves to reflect appropriate levels of exposure- Reviews and approves payments on all cases within assigned authority- Ensure adequate reserving, communication, and effective resolution on attorney represented or litigated cases- Serves as corporate representative, witness, etc.- Facilitates property claims, work injury and general liability- Instills a safety culture and supports all safety initiativesPreferred Education and Experience- A related degree or comparable formal training, certification, or work experience- 3+ years of experience in claims-handling (case management involving medical, vocational, subrogation / recovery, return to work program, etc.)- Current Casualty Lines Claims Adjuster license (17-02) through the Texas Department of Insurance- Valid Texas driver's license, no DUI, and no more than 2 moving violations in last 2 yearsPreferred Key Competencies- Strong working knowledge of PPO utilization, medical terminology, etc.- Understanding of project management processes- Strong customer service and telephone skills- Intermediate PC skills, including MS Office and a Claims Management System- Bi-lingual (English / Spanish) skills (preferred)- Ability to interface with regulatory agencies, division and corporate staff, professional associations, etc.Physical and Other Requirements- Function in a fast-paced, retail, office environment- Travel by car or plane with overnight stays- Work extended hours; sit for extended periods- Available for emergency contact 24 hours a day11-2015
