Claims Specialist - Workers Compensation

As a member of our Claims team, utilize your knowledge of Workers Compensation Claims to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines. **Responsibilities:** * Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature * Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable) * Alerts Supervisor and Special Investigations Unit to potentially suspect claims * Ensures timely denial or payment of benefits in accordance with jurisdictional requirements * Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure * Negotiates claims settlements within granted authority * Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition * Works collaboratively with Lodestar nurse professionals to develop and execute return to work strategies * Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome * Maintains a working knowledge of jurisdictional requirements and applicable case law for each state serviced * Demonstrates technical proficiency through timely, consistent execution of best claim practices * Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues * Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account\- specific sessions * Authorizes treatment based on the practiced protocols established by statute or the Lodestar Managed Care department * Assists Lodestar clients by suggesting panel provider information in accordance with applicable state statutes. * Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work. \#LI\-Remote Requirements: * **Working knowledge of Workers Compensation regulations for PA jurisdiction.** * Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required * Associate in Claims (AIC) Designation or similar professional designation desired * License required or ability to obtain license within 90 days of employment in mandated states * Familiarity with medical terminology and/or Workers' Compensation * Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously * Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details * Strong verbal, written communication skills and customer service skills gained through previous work experience * Computer literacy, including working knowledge of MS Office Product Suite, i.e. WORD, Excel, PowerPoint * Ability to travel for business purposes, approximately less than 10%.