Claims Administrator role assisting with large loss claims management and achieving company objectives within Zego's expanding claims team in Halifax.
About the role
- Workers’ Compensation Claim Administrator handling claims in multiple jurisdictions and providing exceptional customer service with collaboration across internal resources. Leveraging contemporary technology for claim outcomes and embracing continuous improvement culture.
Responsibilities
- Effectively manage workers’ compensation claims requiring coverage and compensability investigations as identified from First Notice of Loss in multiple jurisdictions.
- Identify co-morbid conditions/prior conditions that may affect the original or ongoing compensability decision of the claim
- Provide benefit oversight and file disposition appropriate for claim complexity and adherence to statutory guidelines for all claims
- Leverage a network of internal partner resources such as: nurses, utilization review, and subject matter experts to help with disposition of the claim
- Identify and investigate potential fraud red flags, inclusive of referral to SIU
- Provide exceptional customer service by establishing and maintaining productive business relationships with internal and external customers through written and verbal communication
- Utilize critical thinking skills to gather and analyze data information to inform critical claim decisions, such as coverage analysis, compensability decisions, escalation of injury complexity, attorney representation, and potential red flags
- Leverage contemporary technology to achieve accurate and efficient claim outcomes
- Consistently demonstrate professional diplomacy during all interactions with customers
- Contribute to a courageous culture that promotes collaboration and inclusion to maximize operational performance and employee engagement
- Embrace a culture of continuous improvement
Requirements
- Prior workers’ compensation insurance claim handling is preferred
- Demonstrated passion for delivering a superb customer experience
- Ability to meet productivity targets in a fast-paced, team-oriented environment
- Excellent written and communication skills with the ability to resolve service issues
- Possess strong time management and organizational skills
- Ability to adapt and flourish using industry-changing workflows
- Demonstrates active listening to attentively meet the needs of our customers and exhibit empathy during difficult situations
- Demonstrated desire to promote an inclusive culture of continuous learning that is built on teamwork, collaboration, transparency, and accountability to one another
- Ability to self-manage competing priorities while delivering accurate work within key timelines
- Strong computer proficiency in the MS Office Suite (Word, Excel, Outlook & PowerPoint)
Benefits
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options
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