Claim Representative I - Central

About the role

This organization operates within the workers'' compensation insurance sector, addressing the challenges of managing medical and indemnity claims related to workplace injuries. It focuses on ensuring appropriate compensation by thoroughly investigating claims, determining compensability, and managing reserves and settlements to control financial exposure.

The Claim Representative I - Central is an entry-level professional role responsible for handling workers'' compensation claims involving medical and indemnity benefits. The position plays a critical role in evaluating claims, negotiating settlements, and facilitating the return to work process, thereby contributing to effective claims resolution and cost management.

Responsibilities

• Verify workers’ compensation coverage for employers and injured employees.
• Investigate claims to determine compensability.
• Assess causal relationships between reported injuries and incidents.
• Facilitate injured employee return to work.
• Establish and adjust claim reserves within authority limits.
• Document claims with subrogation potential.
• Manage and approve medical bills related to claims.
• Close claims timely and in compliance with legislation.
• Negotiate settlements with attorneys or injured parties within authority.
• Collaborate with management on complex or high-value files.
• Oversee outside vendors for cost containment.
• Maintain effective relationships with internal and external stakeholders.
• Stay informed on workers’ compensation laws, case law, and rehabilitation advancements.

Requirements

• Bachelor’s degree in a related field or equivalent education and experience.
• Minimum of one year relevant experience or completion of claims trainee program.
• Certification or progress toward certification is preferred.
• Bilingual skills preferred.
• Proficiency with computers and standard software.
• Knowledge of medical and legal terminology.
• Familiarity with workers’ compensation laws and regulations.
• Strong oral and written communication skills.
• Customer service and negotiation skills.
• Ability to manage multiple priorities and meet deadlines.
• Attention to detail and analytical skills.
• Ability to work independently and collaboratively.

Pay

Actual compensation depends on internal equity, candidate skills, experience, location, market, and other factors. Estimated range for this role is $48,200 to $80,750.