Analyzes insurance regulations and legislation, evaluates operational impacts, monitors compliance action plans, coordinates claims and rate system revisions, prepares regulatory submissions, investigates consumer complaints, conducts compliance assessments and audits, and supports operating companies with regulatory requirements. Provides guidance to associates and applies expertise in workers’ compensation regulations, insurance contracts, state audits, EDI compliance, and claims operations.

Independently investigate, evaluate, and resolve complex workers' compensation claims. Determine coverage and reserves, negotiate settlements, manage medical/disability and litigation strategies, coordinate with nurses and vendors, ensure timely payments/denials, and maintain compliance with jurisdictional statutes and client service expectations.

Independently investigate, evaluate and resolve complex workers' compensation claims. Determine coverage, manage reserves, coordinate medical and litigation strategies, negotiate settlements, work with vendors and PMA nurses, ensure jurisdictional compliance, and provide client-facing service.