Claims Analyst II
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Job Location:
Chesterfield, NH - USA
Monthly Salary:
Not Disclosed
Posted on:
4 days ago
Vacancies:
1 Vacancy
Job Summary
Company Details
Why MEC
At Midwest Employers Casualty (MEC) we combine the stability of a Fortune 500 company with the agility of an innovative team. We are passionate about improving the quality of life for employees severely injured on the job and helping companies understand and mitigate risk. Our culture values collaboration curiosity and continuous learning. If you want to make an impact work on meaningful projects and grow your career in a supportive environment MEC is the place for you.
Responsibilities
The Claims Analyst II is responsible for managing high-exposure Workers Compensation claims. The primary job objectives are to proactively mitigate loss costs and settle claims by developing relationships and influencing MECs customers and claim administrators. The role also leveragesAdvanced Analytics and Assisted Intelligence (A.I.) toolsto enhance claim evaluation reserve accuracy and settlement strategies supporting data-driven decision-making and continuous improvement.
Key functions include but are not limited to:
- Accurately evaluate WC claims for potential exposure and establish appropriate reserves
- Utilize predictive analytics and A.I. driven tools to provide insight into complex medical issues evaluate trends and explore potential exposures
- Lead evaluation mitigation and resolution of WC claims by collaboration with MEC Medical Management Consultants Client Consult Managers and Claims Attorneys
- Achieve settlement and vendor goals and objectives
- Adhere to departmental Best Practices by:
- Establishing reviewing and adjusting case reserves in a timely manner within proper authority levels supported by data driven insights and A.I. assisted tools.
- Identifying and influencing appropriate MEC vendors
- Identifying and achieving claim settlement agreements and obtaining necessary authority to finalize resolution
- Maintaining well documented claim files supported by an effective and current diary system on all assigned claims
- Influence TPA adjusters to adopt MEC recommended claim handling strategies
- Plan and conduct on-sight Third Party Administrators (TPAs) visits to promote loss mitigation vendor utilization and timely settlement across assigned portfolio of claims
- Collaborate with Regional Team colleagues to support business growth and client retention through consultative engagement
- Review and authorize reimbursements
Qualifications
- Bachelors in general studies liberal arts or business.
- Requires a minimum of five years of California Workers Compensation experience obtained within the past eight years or successful passage of the California SelfInsurance Exam with consistent employment following certification.
- Frequent usage and general knowledge of WC industry accepted claim handling practices and standards with a minimum of 5 years of primary claim handling experience.
- High level of influence management skills.
- Ability to prioritize organize and meet deadlines.
- Ability to analyze issues and barriers find solutions and effectively implement solutions.
- Ability to work effectively in a team environment under general supervision.
- Ability to communicate frequently and effectively to internal and external contacts using both verbal and written communication skills.
- Ability to learn and maintain skill levels in an electronic environment.
- Working toward CPCU or AIC credentials preferred.
Additional Company Details
The actual salary for this position will be determined by a number of factors including the scope complexity and location of the role; the skills education training credentials and experience of the candidate; and other conditions of employment.
Sponsorship Details
Required Experience:
IC
About Company
Berkley is a leader in commercial lines insurance, with over 60+ specialized businesses - each with deep expertise in an industry, product, or regional niche.
