Promptly investigates each claim in accordance with the claims department best practices.
Initiates contact with insureds , claimants, witnesses, attorneys and other appropriate parties.
Reviews and evaluates policy coverage provisions , business classifications and underwriting guidelines.
Directs counsel on approved declaratory judgement actions.
Reviews and audits all vendor invoices.
Controls investigation assignments made to independent adjusters and other vendors.
Sets initial reserves and ensures proper reserve evaluations throughout the life of the claim. 
Pursues potential opportunities using experienced judgement for recovery including subrogation, indemnification and /or contribution.
Investigate, negotiate reserves and resolve all claims within my authority level.
Maintains an organized claim file, including appropriate file documentation   

 

Review , analyze and prepare pro rate accounts. 
Process and bill reinsurers for proof of loss. 
Maintain all related statistical records and treaty experience/contract history records using Excel.
Collect and process incoming funds from reinsurers.
Maintain files on a monthly basis.
Request letters of credit and maintain applicable records and exhibits interface on a direct basis with client markets.

Handles assigned worker compensation claims accounts, to achieve established goals and objectives. 
Collaborates over the phone with attorneys, medical personnel and employers to gain information for claims. 

Maintains insurance product and company reputation by complying with federal and state regulations: travel to hearings, mediations  and file review when appropriate.
Contributes to team in effort by accomplishing results for successful claim management as outlined.
Explains benefits and procedures to employers and injured workers over the phone and coordinates.

Work directly with NCM’s  Manage Care, Bill Review Specialist and MSA companies on a daily basis. 
Manage all aspects of investigation activity on complex workers compensation claims; primarily handling PA , NJ, DE claims. 
Handle lost , litigated , medical claims for above jurisdictions. 
Directs the discovery and litigation strategy with legal counsel. 
Determines policy coverages and determines if coverage apply to claims submitted; establish reserves and authorizes payments within scope of authority, settling claims in the most cost-effective manner and ensuring timely issuance. 

Manage 180 claims for PA, NJ, DE
Send out legal notices as required by each state.
Responsible for handling complex litigated and non litigated workers compensation claims from beginning end.
This includes investigating , evaluating, negotiating and settling lost time claims. 
Determine whether the claim is compensable , coordinate care for injured worker by approving and authorizing treatment .
Work with the employer to get the injured worker back to work. 
Pay bills on the file, which include wages to the injured worker for time unable to work