Claims Analyst

About Acrisure:

Acrisure is a global Fintech leader that combines the best of humans and high tech to offer multiple financial products and services to millions of businesses and individual clients. We connect clients to solutions that help them protect and grow what matters, including Insurance, Reinsurance, Cyber Services, Mortgage Origination and more.

Acrisure employs over 17,000 entrepreneurial colleagues in 21 countries and have grown from $38 million to $4.3 billion in revenue in just over ten years. Our culture is defined by our entrepreneurial spirit and all that comes with it: innovation, client centricity and an indomitable will to win.

Job Summary:

This role manages the claims process, ensuring all claims are handled fairly and efficiently. Key duties include communicating with insurance carriers, internal counsel, and external counsel to facilitate timely resolution of claims. The specialist also identifies claims with potential third-party liability and gathers comprehensive documentation to support the claims process. It requires a solid understanding of claims management practices and the ability to handle complex cases independently. Strong analytical and problem-solving skills are critical for success. The role involves working on problems of diverse scope and demonstrating good judgment in selecting methods and techniques for obtaining solutions, requiring full knowledge of its functional responsibility.
 

Responsibilities:

• Receives lost time assignments.  Verifies and determines applicability of coverage.  Completes 24 hour contact with employer, employee and attending physician inclusive of telephonic contact, recorded statements and/or in person interviews with insured, employee, physician, and witnesses.

• Reviews all coverage issues and determines compensability within Midwest standards. 

• Aggressively manages all aspects of the workers’ compensation claims management process inclusive of litigation, and providing direction to defense counsel.

• Responsible for customer relations management, consistently establishing and maintaining high levels of trust and confidence with clients, through constant contacts, prompt response and resolving client’s questions and claim issues.

• Responsible for setting of reserves to Ultimate Probable Cost (UPC).  Sets reserves for anticipated exposure subject to authority limits.

• Addresses timely benefit delivery including production of benefit notices to the injured party as required in the applicable jurisdiction. 

• Coordinates return to work (RTW) in accordance with the medical disability plan for the injured worker.

• Negotiates settlements directly with the injured worker or opposing counsel.

• Considers Medicare’s interests related to Conditional payments and injured workers eligibility and settlements. 

• Recognizes and manages 3rd party liability and subrogation through recovery.

• Reviews medical and expense bills for causal relationship and bill charges over $1500.00.

• Consults with Claim Supervisor/Claims Manager/Executive claims on files where assistance and consultation are needed.

• Completion of Claim Status reports.

• Makes assignments to nurse case management when indicated, monitoring their billing and performance.

• Coordinate claim review meetings with both internal and external parties.

• Attend hearings and depositions when required.

• All other duties as assigned.

Acrisure is committed to employing a diverse workforce. All applicants will be considered for employment without attention to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran, or disability status.  California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at www.Acrisure.com/privacy/caapplicant.
 

To Executive Search Firms & Staffing Agencies: Acrisure does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered Acrisure’s property, and Acrisure will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting Acrisure’s Human Resources Talent Department.