Claims Specialist

JOB PURPOSE :

Manage all claims while under the general supervision of the Claims Director. Provide monthly updates and reporting. Coordination and database management; and other projects as assigned by the management team.

ESSENTIAL RESPONSIBILITIES :

Receive initial notification of claims and guide employees on how to properly manage the circumstances.

Investigate claims for cause, compensability, and liability.

Track the receipt of the appropriate paperwork for all claims, set up claim files, and enter information into the Risk Management Information System (RMIS) upon receipt.

Oversee reporting of automobile, general liability, property, and worker’s compensation claims to Miller Pipeline’s insurance carriers and TPAs. Forward necessary information to insurance carriers and maintain accurate documentation of claims by placing copies of all related paperwork in RMIS.

Actively track open claims and interface with Miller Pipeline’s insurance carriers, physicians, and other third parties to ensure that claims are being managed aggressively.

Collaborate with the adjusters on insured claims during investigation, reserving and settlement consults.

Negotiate, settle, process payments and pursue subrogation for nominal claims.

Responsible for managing all third-party subrogation claims for which the company is not liable.

Manage and coordinate Return to Work program for injured workers.

Prepare operations and risk reports for management analysis. Provide benchmarking information as necessary.

Analyze and classify risks as to frequency and potential severity and measure the financial impact of risk on the company.

Respond to inquiries and complaints from customers, regulatory agencies, and members of the business community.

Identify trends and collaborate with Safety Department to identify which safety issues are driving frequency and severity in company’s auto, worker’s compensation, and property damage losses.

Participate in the quarterly claim reviews with the insurance carrier.

Provide Quarterly claim updates to Regional Operations.

Attend Safety incident review meetings and update the RMIS accordingly.

Attend Claim Summits, Safety Meetings and Compliance Trainings as needed to present field personnel with information regarding damage reporting.

Participate in the Claims Presentation during Foreman Leadership Training.

Other duties as assigned.

QUALIFICATIONS :

Education and Certifications

Required

High school diploma. Significant post-secondary course work.

Preferred

: Bachelor’s degree from accredited university

and / or 5+ years’ experience, Adjuster’s License and / or Insurance / Claims Designation or willing to obtain.

Experience

Required

3+

years’ experience in multi-line claims. Data Entry – MS Office experience.

Preferred

Multi-state worker’s compensation, auto, and general liability claims

Functional / Technical Competency Requirements

Required

Working knowledge of auto, general liability, property and worker’s compensation coverage. Knowledge of medical terminology and treatment protocols along with laws, legal codes, court procedures, precedents, government regulations, executive orders and agency rules. Read, analyze and interpret common scientific and technical journals, financial reports, and legal documents. Sense of urgency in responding to inquiries and complaints. Effectively present data to management team, public groups, and / or boards of directors.

CORE COMPETENCY REQUIREMENTS :

Management

Leadership

Business Expertise

Sound Judgment

Presentation Skills

Communication

ESSENTIAL FUNCTIONS :

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel objects, tools, or controls; and reach with hands and arms. The employee is occasionally required to stand, walk, climb or balance and talk or hear. The employee is occasionally required to lift up to 20 pounds.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

Federal Labor Standards Act designation – Exempt

Miller Pipeline retains the discretion to add to or change duties of this position at any time. This position description should not be considered all-inclusive.