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Senior Claim Representative - Texas Non-Subscription

Senior Claim Representative - Texas Non-Subscription

Job ID 
22418
# Positions 
1
Location 
US-TX-Frisco
Posted Date 
10/30/2017
Category 
Claims
Position Type 
Full Time
Travel Percentage 
0 to 10%

Job Information

Overview

Be Here. Be Great.  Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group, a member of American Financial Group, is a Fortune 500 company consistently recognized as a top place to work.  We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty property and casualty operations and a variety of financial services, there are always opportunities here to learn and grow.

 

The ECA Division provides an affordable alternative to Texas Workers' Compensation coverage via the Texas non-subscriber program. ECA has successfully developed and managed the leading non-subscription program in Texas. 

 

ECA is currently searching for a Senior Claim Representative in our Frisco office. The successful candidate will show empathy toward employees, address employee medical questions, coordinate and direct medical treatment with doctors and providers, and partner with the employer to successfully return the employee to work. This position also requires the proven ability to conduct coverage, liability and damage investigations to resolve employer’s liability claims.  This fast-paced position will require attention to detail, time management skills, excellent written and verbal communication skills, and strong organizational skills. 

Responsibilities

  • Confirms and evaluates coverage and liability of varying complexity medical, indemnity and liability claims. 
  • Monitors and facilitates medical treatment to ensure appropriate, cost-effective, quality care.
  • Secures and analyzes necessary information (i.e., expert reports, policies, appraisals, releases, statements) to properly investigate claims.
  • Takes recorded statements.
  • May attend arbitrations, mediations, depositions, or trials as necessary. 
  • Effects settlements and reserves within prescribed time limits and submits recommendations to management on cases exceeding personal authority. 
  • Conveys moderately complex information such as coverage determinations, liability decisions, and case outcomes, to all appropriate parties, while maintaining a professional demeanor. 
  • Ensures that claim payments are issued in a timely and accurate manner. 
  • Performs other duties as assigned. 

Qualifications

  • Must have a minimum of 3-5 years of workers’ compensation or Texas non-subscription medical management experience. A TX adjusting license is required.
  • Ability to manage outside vendors and legal counsel, as necessary.
  • Experience in General Liability investigations, evaluations and accompanying litigation is valuable and preferred.
  • Bachelor's degree and/or AIC, CPCU, SCLA, and other insurance related designations are highly regarded. 
  • Prior experience in the medical field or as a nurse case manager is a plus.
  • While not required, bilingual Spanish-speaking skills are a plus.

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