Position Summary:
As a Workers' Compensation Claim Consultant at Insurate, you will be responsible for partnering with adjusters at our third party administrator to manage and resolve workers' compensation claims, ensuring that they are handled efficiently, fairly, and in compliance with all applicable laws and regulations. This role will not directly handle a caseload of pending claims, but will work closely with agency partners, policyholders, injured workers and our TPA, providing expert advice, guidance, and direction throughout the claims process to ensure optimal outcomes and compliance with all service guidelines and best practices.
The ideal candidate will be detail-oriented, have strong analytical and problem solving skills, and the ability to work effectively within a team and across organizations to resolve disputes and achieve the best outcomes for our clients. This is a remote position and reports to the company’s Chief Claims Officer.
Essential Duties and Responsibilities:
- Strong understanding of workers' compensation laws, benefits, and claim adjudication processes.
- Prior insurance carrier or TPA experience in multiple jurisdictions, with preference given to IL, MO, IN, GA and/or TX
- Communicate with insureds, carriers, attorneys, and agency partners throughout the life of a claim.
- Collaborate with adjusters to establish resolution plans based on case facts, best practices, protocols, and regulatory issues.
- Organize and participate in claim review meetings and new business presentations.
- Maintain file dairies for follow up with adjusters and policyholders
- Collaborate with business development, underwriting, and agency partners to ensure profitable growth and successful execution of business strategies
- Monitor file reserves for timeliness and adequacy, provide input and approval as necessary, and ensure compliance with file handling guidelines and best practices.
- Stay informed about industry trends, market conditions, and regulatory changes affecting workers compensation insurance.
- Provide excellent customer service by addressing inquiries, concerns, and providing guidance to clients and stakeholders.
- Contribute to the development of claims handling policies, guidelines, and procedures.
- Other duties as developed or assigned.
Qualifications:
- Bachelor's degree in Business, Finance, Insurance, or related field.
- Five (5) or more years experience as a workers compensation claims adjuster.
- In-depth knowledge of workers compensation insurance regulations, policies, and procedures.
- Strong analytical and decision-making skills.
- Excellent communication and interpersonal skills.
- Proficient in using claims software and other relevant tools.
- Ability to adapt to a fast-paced and dynamic work environment.
- Relevant insurance certifications (e.g., CPCU, AIC) are a plus.
Performance Indicators:
- Continuous improvement in claim metrics including cycle time, average total incurred, reserve adequacy and others.
- Increase in market share for workers compensation insurance within the target market.
- Monitoring and analyzing claim trends to identify opportunities for improvement.
- Customer feedback and satisfaction scores related to claims processes.
- Timely resolution of customer inquiries and concerns.
- Feedback from external partners regarding the quality of claims support.
- Utilization and effectiveness of data and analytics tools for claim resolution.
- Continuous improvement in leveraging data insights for claim decisions.
- Participation in ongoing training programs and professional development opportunities.
Compensation and Benefits:
- Annual salary range of $60,000 to $90,000 and benefits package including health insurance, dental insurance, vision insurance, 401(k) plan, and paid time off.
- Meaningful participation in Insurate’s equity program. All Insurate employees are part owners of the company.
Additional Information:
- Remote-First Workplace: At Insurate, we recognize the importance of providing a flexible and inclusive work environment that allows our employees to thrive while maintaining a healthy work-life balance.