Senior Claims Examiner

Come work at a place where we take pride in creating a workplace environment that values hard work, commitment, and growth.

Education:

• Associate's or Bachelor's degree preferred in Business Administration or similar field of study
• Active Texas All Lines Adjuster license
• Demonstrated progress towards or completion of formal insurance industry designations is preferred

Work Experiences:

• Minimum five (5+) years of claims management experience or equivalent combination of education and experience required including working with workers' compensation, property and general liability claims preferably in an insurance related or Risk Management industry
• Texas non-subscription claims experience preferred but not necessary
• Moderate litigation claims experience (3+ years)

Skills:

• Ability to engage people effectively and deliver results using strong influence management skills
• Ability to consistently apply sound judgment, and operate professionally, effectively and ethically as an individual contributor and member of a team
• Superior interpersonal, written, and verbal communication skills, with the ability to create thorough documentation and interface effectively with individuals at various levels
• Excellent time management skills, ability to support multiple projects, and effectively prioritize and manage a large volume of work
• Ability to remain organized, pay strict attention to detail, and meet critical deadlines within a high volume, fast-paced environment
• Analytical with strong problem-solving abilities and creative resolution skills
• Strong technical claims knowledge
• Maintain professional and technical knowledge by attending educational workshops and reviewing technical publications
• Proficient use of Microsoft Office programs, including Word and Excel
• Acceptable level of hearing and vision to perform job duties

Responsibilities:

• Understands and performs domestic and/or international claim programs, policies, and procedures for: reporting, investigation, and analysis; file reserves, resolution/outcome management; and the delivery of claim information.
• Moderate litigation management including identifying early settlement opportunities
• Manage claims and insurance files, including litigated and complex matters
• Reviews first and third party claims for irregularities, accuracy and completeness
• Manage technically complex workers' compensation and Texas non-subscription claims
• Manage technically complex general liability, auto liability and property claims
• Partner with external TPA and/or insurance carriers as needed
• Monitor claim files to ensure that external TPA is managing files appropriately and in accordance with Claim Service Instructions, establishing appropriate reserves, and issuing benefit payments timely
• Assist in claims cost control
• May perform design, analysis, and delivery of claim-related information
• Secure evidence related to claims (e.g. merchandise, statements, photos and video footage)
• Conduct management training on the proper handling of work place injuries, submitting incident injury forms and the procedures for substance abuse testing. Maintain strong and collaborative relationships, serving as a strong advocate of new and enhanced solutions or processes throughout the department and organization
• Leverage as a backup to management where needed
• Coordinate substance abuse testing for post-accident, reasonable suspicion, and property damage to include communication of results to appropriate stakeholders
• Partner with management on the status of injured team members and estimated return to work date
• Coordinate return to work efforts
• Notify HR and Payroll of team members who have been placed on leave due to a work-related injury
• Maintain current on changes in workers' compensation laws and other claims-related laws, regulations, and information by attending educational workshops and seminars
• This role focuses on operational effectiveness in support of claims management strategies
• Develop a thorough understanding of Academy policies, procedures and safety rules
• Duties may change; Team Members may be required to perform other duties as assigned

Physical Requirements & Attendance:

• Acceptable level of hearing and vision to perform job duties
• Adhere to company work hours, policies, procedures and rules governing professional staff behavior

Academy is an Equal Opportunity Employer and does not discriminate with regard to employment opportunities or practices on the basis of race, religion, national origin, sex, age, disability, gender identity, sexual orientation, or any other category protected by law.