So whether you’re a veteran insurance professional or a recent college graduate, take a look at United Heartland. You’ll be glad you did.

SUMMARY:

Manages the daily operations of the Claim department to achieve United Heartland's growth and underwriting profitability based on high performance self directed work team and effective claim process management.

RESPONSIBILITIES/TASKS:

• Selects, motivates, and coaches staff, reviews performance, recommends salary adjustments when appropriate, and maintains a favorable employee relations environment to ensure a competent, productive, and motivated workforce.
  
• Manages and coordinates the review and investigation of the compensability of the employee injury under workers' compensation.
  
• Manages and coordinates the review of workers' compensation claims to determine proper payment of medical claims and/or proper wage benefits for indemnity claims and the preparation of settlement recommendations for review with defense attorneys and/or customer clients.
  
• Manages and coordinates the referral of injured employees to rehabilitation or medical vendors and the monitoring of rehabilitation progress to facilitate early return to work for these employees.
  
• Coordinates staff working with defense attorneys and/or customer clients in negotiating settlements to indemnity workers' compensation claims, preparing cases for litigation and for representing United Heartland at pre-hearings, administrative hearings and conferences with state regulatory agencies.
  
• Establishes and maintains effective working relationships with corporate customer/clients and coordinates the customer claim reviews including discussion related to claim investigation, rehabilitation efforts, disability status, and/or settlement activity. Conducts on-site visits as necessary.
  
• Reviews incoming workers' compensation claims and assigns them to Claims Representative; reviews status of work in progress to ensure files are closed and payments are made in an accurate and timely manner, adjusting workloads as necessary. Reviews all external communication regarding claim investigation and status.
  
• Reviews, investigates and settles on payment for the most serious and catastrophic indemnity workers' compensation claims.
  
• Identifies needs for enhanced claim review processes, developing and implementing new or revised claim review procedures. In addition, identifies and analyzes problems with the claims system and works with the designated system liaison to resolve any system problems.
  
• Identifies training needs for the department, developing and conducting department training with assistance of Training Manager as appropriate.
  
• Reviews claims files referred for possible subrogation or second injury fund and authorizes cases to be referred to collection agencies, to pursue in small claims court, or refer to attorneys.
  
• Stays abreast of changes in workers' compensation statue, case law and in rehabilitation efforts/advancements in order to accurately apply and interpret laws for proper payment of claims, to facilitate early return to work for injured employees, to negotiate settlements to claim cases, and to prepare for litigation.
  
• Adheres to the Employee Code of Ethical Conduct and completes additional responsibilities as requested. Participate in development of annual departmental budget, monitor budget and identify budget discrepancies. Research cause and make recommendations.
  
• Responsibility for balancing workload to optimize the effectiveness of the department.

DIRECTION EXERCISED:

Directly supervises exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include but are not limited to effectively interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required

EMPLOYMENT QUALIFICATIONS:

EDUCATION OR EQUIVALENT EXPERIENCE:

Bachelor's degree in Business Administration, Health Care or related field OR the equivalent in relevant course work and experience is required.

EXPERIENCE:

Five - seven years previous experience reviewing, investigating, and settling serious indemnity workers' compensation claims, such as litigation, rehabilitation, and permanent disability claims, to include effectively working with attorneys, rehabilitation and medical vendors, and corporate clients and preparing settlement recommendations. Thorough working knowledge of workers' compensation statutes and workers' compensation filing procedures, of medical terminology and of various settlement methodologies. Previous supervisory or senior experience in the workers' compensation field is required. Previous Claims Management experience in the Workers' Compensation field is desired.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.

Ability to work with and empower others on a collaborative basis to ensure success of unit team.

Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.

Ability to effectively present budgetary and/or cost information, and respond to questions as appropriate.

Ability to establish workflows, manages multiple projects, and meets necessary deadlines.

Effective leadership skills are essential. This position requires the ability to establish short-term and long-range action plans, objectives, and staffing needs; to schedule and coordinate department activities and to select, train and coach employees.

Effective oral/written communication and customer service skills are essential.

Must possess strong negotiation skills and decision-making ability.

Proficient in Microsoft Windows.

Must be able to meet strict deadlines with a high level of accuracy.

Strong attention to detail and analytical skills required.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Position may require up to 25% travel.

The qualifications listed above are intended to represent the minimal skills and experience levels associated with performing the duties and responsibilities contained in this position description. The qualifications should not be viewed as absolute standards, but as general guidelines that should be considered with other position-related criteria.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.