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Sr. Claims Examiner, WC

Role overview

Qualifications

  • Four-year college degree or comparable claims work experience; AIC or similar designation
  • 5+ years’ experience in progressive claims roles
  • Experience handling MD workers’ compensation claims
  • Ability to understand and analyze policy coverages

Responsibilities

  • Conducts prompt and thorough investigations of workers’ compensation claims within departmental and regulatory guidelines
  • Advocates for the injured worker and engages with nurse case management to mitigate lost time
  • Evaluates coverage, determines compensability, and utilizes negotiation skills to resolve claims
  • Accurately applies the HMIG reserving practice by continually evaluating claim exposure

Key facts

Other skills

  • Negotiation
  • Verbal Communication Skills
  • Problem Solving
  • Teamwork
  • Advocacy
  • Time Management

About the company

Harford Mutual Insurance Group logo

Harford Mutual Insurance Group

Insurance

Harford Mutual Insurance Group, a 2022 & 2021 Ward's 50 TOP PERFORMER; a TOP WORKPLACE by The Baltimore Sun Media Group in 2022; TOP PERFORMER In Employee Experience by DecisionWise in 2020; and Employer of the Year by the Maryland Chapter of the CPCU Society in 2016, is a provider of property and casualty insurance products and services for businesses. We offer tailored coverage coupled with claims service that is fast, fair and responsive. Our products are sold by local independent agents in DE, GA, MD, NC, NJ, PA, SC, TN, VA, WV, and the District of Columbia. MISSION Provide insurance products and services that allow our policyholders to conduct their business with the knowledge that they are protected by a financially strong insurer. We strive for profitable growth through a commitment to individualized customer service and by providing the independent agent with a stable market for quality insurance products. Harford Mutual Insurance Group has been assigned an A.M. Best Financial Strength Rating of A (Excellent).

Company details

Company typeSME
IndustryInsurance
Company size201 - 500

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Job description

WHO WE ARE:

Harford Mutual Insurance Group is a growing, dynamic mutual insurance carrier providing commercial property and casualty insurance products and services to a regional market. Headquartered in Harford County, Maryland, Harford Mutual offers a positive, diverse, and inclusive work environment with a rich company culture. Founded in 1842 on the principles of mutuality, we believe in insuring opportunity through mutual success® for our policyholders, agents, communities, and employees, and invite our employees to continue that tradition with respect, integrity, exemplary service, and personal responsibility.

 

Listed within this posting is the anticipated salary range for this position, plus variable incentive compensation. The final salary offered to a successful candidate may vary and will be dependent on several factors that include, but are not limited to, your business experience, education, and individual capacity. Harford Mutual is a multi-state employer, and this salary range may not reflect positions that work in other states.

 

THE OPPORTUNITY:

The Senior Claims Examiner investigates, evaluates, and resolves workers’ compensation claims and makes recommendations for resolutions from any of Harford Mutual Insurance Group companies.  The incumbent will be expected to handle efficiently and competently medium to high severity claims, and to possess comprehensive knowledge of all coverages and claims handling procedures while providing quality claims service to policyholders and agents.

 

LOCATION:

Hybrid (Bel Air, MD office)

 

WHAT YOU’LL DO:

  • Conducts prompt and thorough investigations of workers’ compensation claims within departmental and regulatory guidelines through telephone, written, and other communication methods with policyholders, claimants, attorneys, witnesses, and others with pertinent information.
  • Advocates for the injured worker and engages with nurse case management to mitigate lost time and facilitate a return-to-work.
  • Demonstrates specialized handling of lost time and lifetime medical cases with focus on long term cost-containment and injured worker advocacy.
  • Provides quality claims service to our policyholders and agents by remaining in constant communication with them throughout the claim lifecycle.
  • Evaluates coverage, determines compensability, utilizes negotiation skills to resolves claims within authority to include ability to draft the respective communications required on the claim.
  • Analyzes information to evaluate assigned claims to determine the extent of loss, taking into consideration coverage, compensability, and future investigation needs. Assign and manage nurse case managers, defense counsel, or other experts on a task assignment basis where necessary.
  • Demonstrate in-depth understanding of workers’ compensation statutes, jurisdictional formwork, regulatory requirements, and changing legal landscape.     
  • Accurately apply the HMIG reserving practice by continually evaluating claim exposure to establish appropriate and timely reserves over the life of the claim and notify claim management when exposure exceeds authority.
  • Maintain a claim diary and comply with departmental diary procedures.
  • Direct and handle subrogation and loss recovery efforts on assigned files.

 

WHAT YOU’LL BRING:

  • Four-year college degree or comparable claims work experience; AIC or similar designation
  • 5+ years’ experience in progressive claims roles;
  • Experience handling MD workers’ compensation claims
  • Ability to understand and analyze policy coverages
  • Ability to analyze information to determine compensability 

 

BENEFITS:

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PHYSICAL DEMANDS & WORK ENVIRONMENTAL FACTORS:

The physical demands described above 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 essential functions.

 

EEO STATEMENT:

Harford Mutual Insurance Group provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

 

Most new hires fall within this range and have the opportunity to earn more over time. Initial placement within the salary range, however, is based on an individual's relevant knowledge, skills and experience for the position.

Base salary is only one component of our competitive Total Rewards package. To learn more, please visit the Perks & Benefits on our website.

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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