• Manages a high frequency desk, which includes primarily medical only claims. • Responsible for the investigation, evaluation, and determination of compensability for work-related injury and disease claims following established guidelines to determine benefit eligibility. • Provides superior service in a cost-effective manner to achieve best possible outcomes and proactively collaborate across the enterprise to ensure alignment of objectives and foster continuous improvement. • Gathers relevant facts by performing three-point contacts with involved parties and completing a thorough claim investigation prior to issuing a compensability determination. • Decides the outcome of claims using sound judgment and applying established policy, procedures, regulations, and guidelines. • Evaluates and establishes an action plan to manage benefits associated with primarily medical only and occupational disease claims to their most cost-effective conclusion. • Determines eligibility of benefits once medical treatment plans have been secured and processed within the designated authority levels. • Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible. • Utilizes proactive reserving behaviors to ensure adequate case reserves which reflect the probable ultimate outcome based on the current known circumstances throughout the life of the claim. • Consults with lost time claims specialists and/or complex claims specialists, director or Claims Product and Operations staff, as needed. • Analyzes reports from external resources such as physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed. • Evaluates and negotiates claim settlements utilizing human relation skills and technical knowledge to achieve the best possible outcome. • Effectively and independently uses available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, timeframes, and internal metrics. • Follows established claims best practices related to medical management, litigation, fraud/abuse and recovery. • Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care. • Along with the claim director, regional vice president and other claims staff, participates in claim reviews, onboardings, etc. for our policyholders and agents. • Proactively collaborates with our policyholders to ensure alignment of objectives and foster continuous improvement.