Serves as a subject matter expert for compensability, medical analysis/financial impact questions, and claim handling procedures. Collaborates with WC claim team to review claims and collaborates on resolution strategies

Maintains a caseload of diaries for major files to consult on and resolve escalated WC issues

Provides reserve and settlement authority for cases exceeding regional authority

Represents the WC claims department when addressing escalated WC claim issues

Prepares for and routinely participates in regional roundtables.

Prepares conference reports on individual claims for discussion and provides proper notice of cases discussed and ensures action is taken by file handler

Works closely with other teams including Claims Legal, Medical Case Review, Analytics, SIU, Marketing, Underwriting, Actuary, and external vendors to resolve WC claim handling and/or contractual issues, identify and resolve issues, and gain alignment on WC claims strategies

Validates claims data and reviews multiple sources of data to assist in making good claim decisions. Provides input, insight, and trend analysis by reviewing and analyzing claim data for claim leadership

Makes recommendations for educational opportunities and training for WC team members to ensure consistency within the entire department. Conducts training as appropriate

Provides technical expertise and input on reserve recommendations to the WC claims leadership

Assists with early identification of Catastrophic cases to evaluate the need for outside Medical Management vendors to utilize their specialized medical expertise and cost-savings programs. Oversees files and vendors through case progression

Reviews files audited by claim supervisors to assist with calibration, accuracy, and consistency

Assists with marketing and implementation of large accounts, ongoing servicing, and reporting issues through the policy term

Serves as point person to identify opportunities for improvement and monitor progress on claim audit action plans implemented by claims teams, and works closely with teams to improve. Reports subsequent progress to claim leadership

Works with the Audit team and Claims Directors to provide ongoing support for WC claim handling, including compliance with claim best practices, reserving philosophy, guidelines, and litigation handling guidelines

Serves as the point person to monitor progress on workers' compensation claims wide audit action plan items implemented by the Workers' Compensation Claims leadership and works closely with teams to report to the workers' compensation claims AVP's

Reviews and evaluates allocated and unallocated expenses for assigned claim region.

Monitors existing and proposed legislation, court decisions and trends pertaining to issues that could impact EMC's handling of WC claims.

Participates in evaluation of vendors and new technology impacting the industry

Serves as a subject matter expert on WC technical tools, marketing tools, and state reporting requirements including EDI and manual filings

Advises and collaborates with WC Claims leadership on approaches to positively enhance customer interactions and reduce undesirable experiences

Leads and/or participates in corporate claims projects.

Develops and fosters relationships within claims, underwriting, and marketing teams to educate agents and accounts on claim services offered by EMC as well as ensure agents receive superior customer experiences and select EMC as their insurer of choice.

Collaborates with Corporate Office Underwriting, Actuary and Marketing departments to track line of business development and review opportunities for improvement.

Bachelor's degree or equivalent relevant experience

Ten years of workers' compensation claims handling experience in progressively responsible roles, including prior experience with large loss claims

Attainment of all applicable state licenses as required

Insurance designations, such as AIC, CIC, AIM and CPCU preferred

Superior knowledge of the theory and practice of the workers' compensation claim function

Superior knowledge of property insurance contracts, construction and weather terminology, as well as policy conditions and court procedures regarding disputes on loss value or coverage

Excellent knowledge of insurance contracts, and legal aspects of court procedures affecting legal liability for property line of insurance

Superior organizational and written and verbal communication skills

Superior investigative and problem-solving abilities

Excellent leadership qualities

Excellent knowledge of applicable computer software and claims systems

Occasional travel; a valid driver's license with an acceptable motor vehicle report per company standards required if driving