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Years of Experience
Risk Analyst IV The candidate will review open lost time workers compensation claims with carrier adjusters for return to work strategy and medical treatment. Negotiate appropriate claim file reserving of individual open lost time claims. Review open loss runs to identify and manage open claims negatively impacting client insurance program. Will claims management agency liaison for Workers Compensation specific insurance carrier partners including, but not limited to, AIM Mutual, Applied Underwriters, MEMIC and Atlantic Charter. Will prepare, facilitate and attend claims reviews with client and carrier. Will create and submit client first reports to respective insurance carrier claims department for clients on assignment. Will provide technical guidance to claim team members, Producers and Account Managers concerning Workers Compensation statutes and claims best practices. Will facilitate individual claim conference calls between client and carrier for claim updates/strategy recommendations/settlement authority. Will establish carrier “special claims service handling instructions” for large new agency claim accounts. Presents agency claims capabilities and service deliverables for new large Commercial client prospects that have high Workers Compensation exposure.
Qualification and Experience
The candidate should have Bachelor’s degree from four-year college or University; or equivalent. Should have 8+ years Workers Compensation carrier claims, self-Insured risk management, or TPA Workers Compensation Claims management experience. Should have in depth knowledge of multi-state (primarily New England) Workers Compensation state statutes. Professional designations (or pursuit of), including CPCU, AIC, CRIS, CISR, or law degree preferred. Ability to read, analyze and interpret documents such as loss runs, insurance contracts, legal documents, medical reports and insurance policies. Ability to respond to complex claim inquiries or complaints from clients, carriers, attorneys or individual plaintiffs. Should have ability to effectively present information to clients, carriers, top management, TPA’s and legal counsel. Experience in MS Word, Excel, Outlook, PowerPoint, etc. is required. Prior experience with AMS 360 is preferred. Should have ability to effectively utilize insurance carrier and TPA claims web-based information systems. Excellent written and verbal communication skills. Should have strong Analysis and judgment skills. Should have proven ability to cultivate relationships with clients and carrier claim partners. Demonstrates effective negotiation and resolution skills. Works well in a team environment.
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