The Insurance Specialist will report to the Insurance Manager within the Risk & Safety Department and work under the guidance of the Director of Risk & Safety Management. The Insurance Specialist will have limited supervisory oversight of the Claims Coordinator(s) and provide guidance and direction for complex or challenging insurance related transactions. This individual provides oversight in the review and processing of documents for all insurance claims and ensures compliance with relevant policies, procedures, regulations, and laws. The Insurance Specialist updates and advises injured employees, program management, and the risk department in the administration of claims.

• Assist the Claims Coordinator(s) in the timely review of accident/incident reports for completeness, accuracy, and determination of additional tasks are needed to complete thorough claims investigations.
• Ensure prompt reporting of insurance claims to SWKs insurance carrier(s) or claims administrator.
• Analyze incidents to determine if the cause of loss may be covered by insurance.
• Monitor all claims to ensure prompt determination of acceptance or denial, legal strategy, investigations, discovery, and any follow up required by SWK staff.
• Communicate frequently with the insurance broker for up an up-to-date loss run reports and other analytical methods of reporting.
• Create periodic (monthly, quarterly, annual, etc.) data analytics for the Director of Risk & Safety that assesses claim trends, frequency, severity, reserve changes, allocated loss adjustment expenses (ALAE), and any other metrics requested.
• Monitor monthly financial transactions related to claims and inquire with the claims administrator of specific costs that may result from inquiries.
• Participate in quarterly file reviews with claims administrators, insurance brokers, carriers, and legal counsel.
• Attend hearings, depositions, status conferences, mediations, and other legal proceedings on behalf of SWK as the Employer Representative.
• Write reports, summaries, memorandum, briefs, and other documentation requested by the Director of Risk & Safety or designee.
• Maintain current knowledge of existing Federal and State laws pertaining to tort liability, workers compensation, employment practices, and other applicable laws that govern the SWK business model.
• Provide technical assistance to management and staff regarding insurance coverage, deductibles, loss reporting, claims investigations, etc.
• Supervises the preparation, maintenance, and retention of insurance records and certificates.
• Oversee and coordinate all insurance renewals, data requests from underwriters, and submission of documentation needed to bind coverage.
• Analyze actuarial reports and provide recommendations for claims handling strategy and loss reserving.
• Reviews legal contracts and certificates of insurance to determine the type and coverage limits of insurance required and indemnification language sufficient to protect SWK from financial exposure.
• Investigate suspected fraudulent insurance claims and make timely reports to insurance carriers, special investigation units (SIUs), and other governmental agencies tasked with investigating and prosecuting insurance fraud.

• Bachelors degree in Business Administration, Finance, Accounting, or other fields applicable to the essential job functions.
• 5-7 years of experience managing insurance claims or adjusting claims across multiple lines of coverage.
• Strong reading comprehension, analytical, and organization skills and abilities.
• Strong skillset in Microsoft Office, especially in Excel and Word.
• Extensive experience using Risk Management Information Systems (RMIS) and other web-based platforms used in claims reporting or investigations.
• Regular and punctual attendance.
• Bilingual English/Spanish (preferred).
• Must be able work in a fast-paced environment where priorities can change frequently.
• Work well with others in a transparent, collective, respectful, and team-building environment.

Must be able to read, write, and communicate both verbally and in written form to express and exchange ideas. While performing the responsibilities of this job, the employee must be able to access all components of workstation and other office equipment. Frequent typing, writing, bending and twisting. Must be able to lift up to 10 pounds.

General office environment with moderate noise. This position is mostly sedentary, involves sitting most of the time, but may involve walking or standing for brief periods of time. A busy environment with many unscheduled interruptions. Frequent computer use at workstation for extended periods of time. Public contact position requiring appropriate business apparel.