Insight Global is looking for a Claims Specialist to join a third party workers compensation organization headquartered in Chicago, IL. The Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department .
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
-Receives claim, confirms policy coverage and acknowledgement of the claim.
-Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies.
-Establishes reserves and authorizes payments within reserving authority limits.
-Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim.
-Coordinates early return-to-work efforts with the appropriate parties.
-Manages subrogation and litigation of claim as it applies.
-Manages potential claim recoveries of all types.
-Reports claims to the excess carrier when applicable.
-Communicates claim status with the customer and claimant.
-Adheres to client and carrier guidelines and participates in claims review as needed.
-Develops and maintains professional customer relationships.
-Complies with rules and regulations of applicable state.
-Additional projects and duties as assigned.
*Preference is local to Chicago, can sit remote!
Previously worked at: Esis, Sedgewick, Gallagher Bassett
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.