Sr Claims Rep (General Liability) - DWF

Job Summary: Conducts all necessary investigations in a timely manner on all types of claims and RTW cases to determine the facts and / or activities resulting in expenses related to the reported incident or case.

Essential Functions / Process Responsibilities (other duties may be assigned)

Handles complex claims and investigations Provides ongoing training for assigned client groups Handles all escalated customer service issues Conducts investigations on all types of claims and RTW cases and provides recommendation for best course of action Reviews and interprets existing, new, or proposed OSHA regulations, updates to department staff as necessary Investigates and documents hazard reviews; analyzes, evaluates, and presents recommendations Coordinates litigation case management to ensure cost containment; attend trials when needed, reports on trial to management, ensures clear and concise communication between defense attorney and management Manage incident reports and determine appropriate action plan Communicates with all partners, customers and other third parties who have filed an incident report to determine an appropriate action plan and to provide the best possible customer service Reviews and evaluates reports of occupational injuries, determine eligibility, and administers any and all benefits due in accordance with the provisions of the Work Injury Benefit Plan Facilitates subrogation/recovery efforts from third parties responsible Coordinates the effective administration of the Return to Work Program Conducts more intensive investigations for referred cases Continuously reviews, sets, and monitors reserves to reflect appropriate levels of exposure Reviews and approves payments on all cases within assigned authority Ensure adequate reserving, communication, and effective resolution on attorney represented or litigated cases Serves as corporate representative, witness, etc. Facilitates property claims, work injury, general liability Instills a safety culture and supports all safety initiatives Serves as subject matter expert and acts as a resource for team members and assigned client groups all claim types Mentors others

Preferred Education And Experience

A related degree or comparable formal training, certification, or work experience 5+ years of experience handling complex litigation case management, high valued cases, high risk cases that involve umbrella carrier, medical management on work injury cases, Return to Work program -, subrogation / recovery management, etc. Current Casualty Lines Claims Adjuster license (17-02) through the Texas Department of Insurance Valid Texas driver's license, no DUI, and no more than 2 moving violations in last 2 years

Preferred Key Competencies

Comprehensive working knowledge of PPO utilization, communication with medical network, medical terminology, etc. Working knowledge of OSHA regulations Understanding of project management process Advanced customer service and telephone skills Advanced negotiating skills Intermediate PC skills, including MS Office and a Claims Management System Bi-lingual (English - Spanish) skills (preferred) Ability to interface with regulatory agencies, division and corporate staff, professional associations, etc.

Physical And Other Requirements

Function in a fast-paced, retail, office environment Travel by car or plane with overnight stays Work extended hours; sit for extended periods Available for emergency contact 24 hours a day

LEG323