AF Group Nationwide Opportunities - Senior Claim Representative I/II

<strong>AF Group (Lansing, Mich.) and its subsidiaries are a premier provider of innovative insurance solutions. Insurance policies may be issued by any of the following companies within AF Group: Accident Fund Insurance Company of America, Accident Fund National Insurance Company, Accident Fund General Insurance Company, United Wisconsin Insurance Company, Third Coast Insurance Company, or CompWest Insurance Company.</strong>

United States, USA

AF Group

<p class="p1"><strong>AF Group&rsquo;s focused and passionate team uses industry-leading best practices, analytics and resources to manage risk and minimize loss for our policyholders while strengthening businesses with our valued independent agent partners.</strong></p> <p class="p1"><strong>We strive to continuously increase the long-term value of our organization by outperforming our industry peers and fostering a culture of underwriting and claims excellence.</strong></p> https://www.afgroup.com/

keywords: job description,work environment,solutions,claims,senior representative,other duties,education,experience,rep ii experience,proficiency,skills

Non-Manager

Competitive Compensation and Benefits Package

Overview: <br />This position serves as a technical expert in the claim handler career path. Under limited supervision, handles claims with litigation, complex/catastrophic, and/or coverage elements. Handles the most unique cases, where little precedence has been established. May handle the most complex, high-touch, or labor-intensive customers. Serves as a department leader by developing other employees and may function as acting manager in the absence of department management.&nbsp;<br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards. Minimal travel required.</p>
Responsibilities: <br /> <p><strong>Senior Claim Representative I, II:</strong></p> <ul> <li>Independently administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.</li> <li>Establishes timely and appropriate reserves based on claim profile and anticipated financial exposure.</li> <li>Represents the Company by working closely with customers, agents, and brokers to resolve the most complex claim issues.</li> <li>Negotiates settlements with attorneys or injured and exercises independent judgment to settle cases prior to mediation or litigation.</li> <li>Manages outside vendors to ensure cost containment efforts.</li> <li>Establishes and maintains effective working relationships with all internal and external customers.</li> <li>Stays abreast of changes in workers&rsquo; compensation statutes, case law, and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws.</li> <li>Actively participates in agent/client relationship management.&nbsp;</li> <li>Mentors team members.</li> <li>May serve as department leader in the absence of management or act as manager designee.</li> </ul> <p><br /><strong>Senior Claim Representative II:</strong></p> <ul> <li>Leads catastrophic claim events with large claim volume.</li> <li>Handles the most unique cases, where little precedence has been established, requiring innovative administration and problem resolution.</li> <li>Acts as liaison to claim consultants as needed to support enterprise initiatives.</li> <li>May provide oversight to vendors.</li> <li>May take lead role in claim projects or initiatives.</li> </ul>
Requirements: <br /> <p><strong>EDUCATION OR EQUIVALENT EXPERIENCE:</strong></p> <ul> <li>Bachelor&rsquo;s degree in a related field.</li> <li>Relevant combination of education and experience may be considered in lieu of degree.&nbsp;</li> <li>Continuous learning, as defined by the Company&rsquo;s learning philosophy, is required.&nbsp;</li> <li>Certification or progress toward certification is highly preferred and encouraged.</li> </ul> <br /> <p><strong>EXPERIENCE:</strong></p> <p>Senior Claim Representative I:&nbsp;</p> <ul> <li>Seven years of progressively more responsible experience in a workers&rsquo; compensation claims environment that provides the necessary skills, knowledge, and abilities, such as experience in reviewing, investigating, and closing the most complex workers&rsquo; compensation claims. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred.&nbsp;</li> </ul> <p>OR</p> <ul> <li>Two years of AF Group Claims Representative III experience that includes independent handling of the most complex claims and/or the most complex, high touch, or labor-intensive customers.</li> </ul> <p><br />Senior Claim Representative II: &nbsp;</p> <ul> <li>Ten years of progressively more responsible experience in a workers&rsquo; compensation claims environment that provides the necessary skills, knowledge, and abilities, such as experience in reviewing, investigating, and closing the most complex workers&rsquo; compensation claims. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred (Spanish language).&nbsp;</li> </ul> <p>OR</p> <ul> <li>Three years of AF Group Claims Representative III experience that includes independent handling of the most complex claims and/or the most complex, high touch, or labor-intensive customers.</li> </ul> <p>&nbsp;</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <p>Senior Representative I, II:</p> <ul> <li>Ability and proficiency in the use of computers and company standard software specific to position.</li> <li>Knowledge of medical and legal terminology related to the work.</li> <li>Knowledge of workers&rsquo; compensation laws and regulations, including jurisdictional laws.</li> <li>Effective oral and written communication skills.</li> <li>Effective customer service skills.</li> <li>Ability to negotiate, build consensus and resolve conflict.</li> <li>Ability to act as a representative of the Company and establish effective working relationships.</li> <li>Ability to manage multiple priorities and meet established deadlines.</li> <li>Attention to detail and analytical skills.</li> <li>Ability to make independent decisions.</li> <li>Ability to solve highly complex problems.</li> <li>Ability to train and mentor others.</li> <li>Ability to lead others.</li> </ul>