Claims Associate - Workers Compensation

About the role

PRIMARY PURPOSE: To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

Responsibilities

• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
• Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.
• Communicates claim action/processing with claimant, client and appropriate medical contact.
• Safeguards claim files are properly documented and claims coding is correct.
• Maintains professional client relationships.

Qualifications

• High school diploma or GED required.
• Licenses as required.
• One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.

Additional Functions

• Performs other duties as assigned.
• Supports the organization's quality program(s).

Work Environment

• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
• Physical: Computer keyboarding, travel as required.
• Auditory/Visual: Hearing, vision and talking.