Website A.I.M. Mutual Insurance Companies
Ensure the equitable and justified investigation, evaluation and settlement/closure of workers compensation claims in accordance with A.I.M. Mutual Insurance Company’s specified service standards, industry requirements and audit procedures.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Evaluate coverage, liability, disability and causal relationship issues as well as potential loss value immediately upon receipt of first report. Investigation practices include direct observation, interviews with concerned parties, reports from policyholders and claimants, and use of consumer reporting agencies. Manage investigation through final disposition in a timely manner with proper diary and reporting documentation throughout.
Evaluate liability, disability and causal relationship based on detailed investigation consistent with industry guidelines, state laws and A.I.M. Mutual’s unique service requirements. Timeliness and thoroughness are key. Begin negotiation process within established authority limits or consult supervisor depending on complexity of case. Work with the employer/policyholder to assess return to work potential. Make recommendations on proper case reserving within established authority guidelines.
Actively engage in negotiation proceeding with claimants and/or policyholders as assigned. Recommend proper course of action to follow (within authorized reserve authority) to achieve fair settlement.
Within authority, provide prompt payment of workers compensation benefits as warranted. Arrange, ensure and monitor initial and ongoing medical care to injured claimants by utilizing rehabilitation measures to return the injured to gainful employment, including modified duty, in the shortest period of time.
Litigation Coordination. Represent company in settlement of meritorious claims and suits expediently and economically; contest claims and defend suits that are without merit. Liaison with vendors. Work with defense counsel on legal handling and litigation management.
Ensure complete and accurate documentation on mandated state and company forms and filings.
Perform on-site service visits as requested or as needed.
Contribute to the establishment of proper case reserves on each claim with supporting documentation.
Ensure accessibility to policyholders at all times.
Ability to meet A.I.M. Mutual Insurance Companies standards.
Ability to work with other departments to meet company standards.
The above is a description of the ordinary duties of the position. It should be expected that from time to time other duties, both related and unrelated to the above, may be assigned and required.
Customer Focused – Makes customers and their needs a primary focus, shows interest and understanding of the needs and expectations of internal and external customers, gains customer trust and respect, meets or exceeds customer expectations.
Detail Oriented – Achieves thoroughness and accuracy when accomplishing a task through concern for all the areas involved
Technical Knowledge and Skills – Possesses professional and technical expertise required to do the job effectively.
Planning and Organizing – Organizes work, sets priorities. And determines resources requirements, determines necessary sequence of activities to accomplish work.
Communication – Clearly conveys and receives information and ideas through a variety of media to individuals or groups in a manner that engages the listener, and helps them understand and retain the message. Demonstrates good written, oral, and listening skills.
This position has no supervisory responsibilities.
This job operates in a professional office environment with occasional exposure to light noise.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee will constantly operate a computer and other office productivity machinery, such as a phone, calculator, copy machine, and computer printer. The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc., and occasionally lift up to 15 pounds.
Position Type/Expected Hours of Work
This is a full-time position. The typical work week is Monday through Friday, 7:00AM to 3:00PM or Monday through Friday, 8:00 AM to 4:00 PM.
No travel is expected for this position.
Required Education and Experience
Minimum three to five years of claim technical experience, with emphasis on workers compensation.
College degree preferred.
Exceptional written and oral communication skills.
Ability to organize and prioritize work flows and meet company/industry deadlines.
Self-motivated, able to work with little direction.
Industry training and professional designation a plus.
This job description is subject to change at any time.