Workers’ Compensation Claims Specialist (Illinois – Hybrid)
Summary of Position
The Claims Specialist will assist the Director of Workers Compensation as well as the Deputy General Counsel of Litigation in overseeing and managing the operational excellence of the Workers’ Compensation Program. The Claims Specialist will play a critical role in ensuring quality claim file management. This will be completed by working with internal (finance and legal) and external partners to drive performance. Proactively manage the day-to-day interface and expectations with the TPA and Transdev finance and legal business partners. Provide technical direction on claim decisions and resolution in partnership with our external Third-Party Administrator (TPA) partner within the assigned authority level.
The Claims Specialist will be expected to act as a subject matter expert and exhibit thought leadership to assist in enhancing collaboration with business partners across Transdev.
Principal Duties and Responsibilities
Claims Quality Assurance (QA)
Responsible for ensuring claims are handled in accordance with established guidelines and service instructions.
Ensures timely completion of file reviews
Identify claim handling trends by applying industry knowledge of the claims process, policies & procedures
Meet regularly with Director of Claims to provide QA results and recommendations for opportunities for improvement.
Claims Technical Oversight
Manage claims to reduce costs and improve outcomes
Direct Third-Party Administrator (TPA) and assign and direct defense attorneys on litigated matters under the guidance of the Deputy General Counsel, Litigation.
Authorize reserve and settlements
Claims Customer Service
Serve as a point of contact for our locations to provide general claim guidance and help set claim process expectations.
Participate in interactions with TPA adjusters and claims partners to drive optimized claims outcomes and top-notch claims experience.
Work to continuously improve our claims operations and look at opportunities and gaps in claim service, handling SOPs, protocols, and processes.
Bachelor's Degree is preferred. A paralegal or some type of legal studies would be helpful but not required.
Experience communicating with lawyers is required.
Minimum of 5-years workers’ compensation claims experience is required.
Strong communication (written and verbal) skills, to deliver more complex information effectively.
Strong problem-solving skills to be able to manage complex tasks and work through to solutions with little guidance and direction.
Demonstrated knowledge and experience in claim adjudication, medical management, and litigation management.
Ability to use skills to overcome conflict and reach beneficial outcomes.
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