PRIMARY PURPOSE:To analyze mid- and higher-level general liability claims todeterminebenefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and toidentifysubrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Manages mid-level general liability claims by gathering information todetermineliability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.

• Assesses liability and resolves claims within evaluation.

• Approves and processes assigned claims,determinesbenefits due, and manages actionplanpursuant tothe claim or client contract.

• Manages subrogation of claims and negotiates settlements.

• Communicates claim action with claimant and client.

• Ensures claim files are properlydocumentedand claims coding is correct.

• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions onappropriate treatmentsrecommended byutilizationreview.

• Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travelsasrequired.

QUALIFICATION

Education & Licensing
Bachelor's degree orcollege diplomapreferred.

Experience
Four (4) years of claims management experience or equivalent combination of education and experiencerequired.

Skills & Knowledge

• Subject matter expert ofappropriate insuranceprinciples and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles

• Excellent oral and written communication

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Good interpersonal skills

• Excellent negotiation skills

• Ability to work in a team environment

• Ability to meet or exceed Service Expectations

Job type:

We are currently hiring for this position

Compensation Information:

Salary Range: $55,000 – $85,000 annually

This position is full-time and compensation is salaried based

Compensation is determined based on experience, qualifications, and internal equity. Company is committed to transparent and equitable pay practices.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Where applicable, Company uses artificial intelligence tools to assist in the screening, assessment, or selection of candidates. These tools are subject to periodic review.