Claim Specialist WC (Specialist, Advanced, or Senior Level DOE)

Join us at HEMIC!

Voted one of Hawai`i Business’ Best Places to Work for 5 Years in a Row!

As a HEMIC employee, you will get:

Voted one of Hawai`i Business’ Best Places to Work, and Pacific Business News’ Best Workplaces, our business is founded on caring for Hawai`i workers, Hawai`i businesses, and each other.

We’re passionate about your development. Whether it’s achieving a formal certification or attending a workshop to improve your communication skills, we will support and encourage you to grow.

We offer competitive salary and best-in-class benefits, including a 401k match, flex-time, generous PTO, 15 paid holidays, and so much more!

Giving back to our community is our kuleana and we offer numerous opportunities for our employees to take part - whether it be volunteering for a fundraiser, attending a charity walk, or getting a match for your charitable contributions.

Why our Claim Specialist is Important:

A company buys insurance for financial security. When an injury or loss occurs, the claimant expects to receive treatment and compensation in a timely manner. Delivery on this is the heart of the claims function and process. Our Claim Specialist carries out our promise of "Proudly Taking Care of Hawai`i" by working with injured workers to get the necessary care so that they can get back to work and life.

Essential Duties

• Timely and appropriate contacts with client or vendor, in accordance with company Best Practice Procedures. Timely follow through.
• Responsible for completion of the 24-hour initial investigation. Evaluate claim exposure, negotiate, and resolve complete claims. Calculate AWW, WCR and process timely indemnity benefits. Attend hearings as necessary and interact with the State of Hawaii DCD-LAB members as appropriate.
• Analyzes assigned new claims and re-openings; and determines applicability of coverage. Determines claim validity and compensability. Identifies questionable claims.
• Performs task of securing Recorded Statements. When applicable, requests for Oral Depositions, Activity Checks and Surveillance.
• Complete appropriate levels of investigation to determine coverage, liability and financial exposures. Ensure timely completion of Reinsurance Reporting of financial exposures meeting the criteria ($250,000.00 and/or catastrophic).
• Maintain quality claim files in accordance with the State of Hawaii WC guidelines and HEMIC’S practices and procedures.
• Will attend and present at claim reviews, Quality Account Management or “QAM” meetings, installation meetings and other account related meetings.
• Identify subrogation potential & recovery.
• Responsible for litigated cases and assess litigation referral for legal opinion whenever applicable and assist defense counsel in developing litigation plan and track adherence to plan to control legal expenses and assure effective claim resolution.
• Establishes reserves based upon Most Probable Ultimate and in accordance with HEMIC reserving policies and procedures and within the authorized authority.
• Assigned to large deductible, Third Party Administration, and special accounts at the discretion of the Claim Manager.
• Keep up to date on State Laws, USL&H and company procedures relating to claims; educate injured worker, insured and /or agent.
• Other duties as assigned.

Requirements

• Broad understanding of the State of Hawaii Workers’ Compensation laws, rules and regulations preferred. Technical claims and legal climate knowledge, a plus.
• State of Hawaii Workers’ Comp Adjusters License, required
• 5 yr. experience in State of Hawaii workers’ compensation with experience in handling lost time and litigated claims, preferred.
• Willing and able to learn USL&H, Defense Base Act, and CBWC claims handling.
• Maintains high level of accuracy.
• Ability to maintain confidential information.
• Able to work independently as well as a collectively as a team.
• Excellent customer service skills, with the ability to effectively communicate with internal and external customers.
• Excellent verbal and written skills.
• Microsoft proficient preferred.
• Strong attention to detail.
• Self-directed and flexible.

Position title

Claim Specialist (multiple levels DOE)

Department

HEMIC – Claims

Work Arrangement

In-Person, HEMIC Tower

Reports To

Manager, Claims

Direct Reports

N/A

FLSA Status

☒ Exempt ☐ Non-Exempt Job Class: 2-Prof

Approved By:

clewis

Date Approved:

11/21/2023

Reviewed:

N/A

NOTE: The above information on this job description has been designed to indicate the general nature and level of work performed by an employee in this classification. It is not to be interpreted as a comprehensive inventory, or all duties, responsibilities, and qualification of employees assigned to this job. Management has the right to add, revise or delete information in this description. Reasonable accommodations will be made to enable qualified individuals with disabilities to perform the essential duties of this position.