The Claims Examiner will provide oversight to workers' compensation claim portfolios handled by Third-Party Administrators ( TPAs ) and address all claim issues by gathering information necessary to make informed decisions to bring claims to an appropriate resolution. Key Accountabilities/Deliverables:
- Oversight responsibilities for TPAs to add value and claims expertise.
- Ensure compliance with established claim handling guidelines regarding coverage, investigation, liability, evaluation, and resolution.
- Establish reserves pursuant to established reserving protocols and reserve authority procedures.
- Create innovative and effective approaches and solutions that have a positive impact on business results and delivers superior claim services that positively impact profitability.
- Adhere to vendor panels.
- Closely manages outside vendors to ensure that loss adjustment expenses are appropriate.
- Promptly identifies claims that have significant exposure or suspected fraudulent activity.
- Work with external customers to address questions, resolve problems, and maintain rapport.
- Work with internal members of various departments to support the marketing, underwriting, and loss control functions. This includes periodic account management meeting attendance and completing forms/reports (large loss reports, distressed accounts, and claim status).
- Undertaking general office administrative duties as needed and when required.
- May be called upon to undertake other job duties from time to time as the Company may reasonably require.
Technical Knowledge and Understanding: - Detailed understanding of good faith claims handling.
- Working knowledge of State specific claims handling guidelines.
- General understanding of legal principles as they pertain to insurance claims.
Experience: - Bachelor's degree or relevant experience.
- Minimum of 3+ years of experience handling Workers' Compensation claims.
- USL&H and Jones Act experience not required, but a plus.
- Multi-jurisdictional experience, including California.
- TPA oversight experience.
Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa for this position. #LI-REMOTE At Core Specialty, you will receive a competitive salary and opportunities for professional development and advancement. We offer medical, dental, vision, and life insurances; short and long-term disability; a Company-match of 100% of a 6% contribution 401(k) plan; an Employee Assistance Plan; Health Savings Account, Flexible Spending Account, Health Reimbursement Account, and a wellness program