[Hiring] Claims Specialist III @UFG Insurance

Role Description

UFG is currently hiring for a Claims Specialist III in Workers Compensation. This role is a highly experienced position primarily responsible for:

• Verifying applicable coverages
• Conducting timely and thorough research of the facts of a loss
• Analyzing compensability and evaluating benefits for reserve and settlement
• Negotiating medium to high complexity claims to resolution in accordance with claims best practices

The Claims Specialist III – WC role demonstrates a strong desire to learn and grow, promotes a positive work environment, and embraces a strong service-oriented mindset in support of internal and external customers. This role requires:

• Strong communication skills
• Attention to detail
• The ability to handle multiple tasks efficiently and effectively
• The ability to work independently with a low level of supervision and a high level of accountability
• A strong desire to advance one’s professional development and the development of others

Essential Duties and Responsibilities:

• Review claim assignments to determine policy coverage and compensability of a claimed injury or illness
• Make prompt, meaningful contact with insureds and their employees to research facts
• Establish rapport and an outcome-focused relationship with insureds and their employees
• Request and analyze medical records to determine compensability
• Interact with medical providers to define medical causation and establish treatment plans
• Inform insured and employees of coverage and compensability decisions
• Support stay-at-work or return-to-work opportunities for insureds and their employees
• Identify subrogation potential and document evidence in support of subrogation
• Identify potential Medicare eligibility and comply with all Medicare Secondary Payor requirements
• Assess and periodically re-assess the nature and severity of injury or illness
• Assess and periodically re-assess claim file reserves to a high degree of accuracy
• Execute all technical claim handling functions
• Proactively seek resolution of claims through negotiation and mediation
• Comply with statute specific claims handling practices and reporting requirements
• Inform underwriting of increased hazards or unusual circumstances
• Participate in internal and external continuing education opportunities
• Demonstrate a supportive attitude and presence within the team
• Demonstrate interest in one’s own career development and actively support peers

Qualifications

• High school diploma required
• Post-Secondary education or Bachelor’s degree preferred
• Meet the appropriate state licensing requirements to handle claims
• Complete the Workers’ Recovery Professional (WRP) certification program within 1 year of hire
• Complete the Senior Workers’ Compensation Law Associate (SCLA) designation program within 3 years of hire
• Willingness to pursue other professional certifications or designations as requested
• 5+ years of general work experience
• 10+ years of workers’ compensation claims handling experience or a combination of related experience

Requirements

• Proficient knowledge of insurance, medical, and legal concepts
• Strong communication skills
• Analytical and critical thinking abilities
• Service-oriented mindset
• Proactive decision-making and problem-solving skills
• Time management and sense of service urgency
• Aptitude for mentorship and leadership

Benefits

• Annual incentive compensation
• Medical, dental, vision & life insurance
• Accident, critical illness & short-term disability insurance
• Retirement plans with employer contributions
• Generous time-off program
• Programs designed to support employee well-being and financial security

Working Conditions

• Working remote from home or general office environment
• Occasionally requires working irregular hours
• Infrequent overnight travel and weekend hours may be required

Pay Transparency Statement

UFG Insurance is committed to fair and equitable compensation practices. The base salary range for this position is $71,598 - $94,396 annually, which represents the typical range for new hires in this role. Individual pay within this range will be determined based on a variety of factors, including relevant experience, education, certifications, skills, internal equity, geography, and market data.