Claims Representative

Responsibilities

• Investigate workers’ compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due
• Calculate and set timely financial reserves and proactively manages reserve adequacy throughout claim lifecycle
• Record and code injured worker demographics, job information and accident information in company’s claims management system and files necessary forms with state regulatory agencies
• Issue timely payments to injured workers, medical providers and service vendors
• Cookinate and actively manage medical treatment of injured workers to ensure timely rehabilitation
• Negotiate settlements of claims within designated authority with injured workers and attorneys
• Demonstrate a working knowledge of the Workers’ Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictions
• Identify and manage subrogation, Second Injury Fund and joint coverage recovery opportunities
• Regularly communicate claim activity and status updates to policyholders, injured workers and other interested parties in a professional, thoughtful and tactful manner
• Respond in a timely manner to communications from policyholders, injured workers, and other interested parties
• Notify management and develops reports for large exposure claims and complies with reinsurance reporting requirements
• Manage the claims litigation process to ensure timely and cost-effective claims resolution
• Monitor the expenses and effectiveness of managed care and investigation vendors
• Actively participate in special projects as assigned by management
• Periodically travel to attend hearings, conferences and training sessions
• Attend and participates in claim file reviews with management and defense attorneys
• Continuously strives to improve our product and business results through innovation

Qualifications

• Excellent written and verbal communication skills
• Strong interpersonal and relationship building skills
• Exceptional time management and organization skills
• Strong analytical and critical thinking skills
• Ability to work independently and strategically problem solve
• Ability to diplomatically manage conflict
• Ability to develop relationships within the organization and work effectively across departments
• Strong discretion and integrity in dealing with highly confidential and sensitive information
• Detail oriented

Education

• Bachelors’ degree or equivalent insurance industry work experience

Additional Company Details

• The Company is an equal employment opportunity employer
• We do not accept any unsolicited resumes from external recruiting agencies or firms.
• The company offers a competitive compensation plan and robust benefits package for full time regular employees
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
• Base Salary Range: $65k-$75k
• The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
• Additional Requirements: Low level of domestic U.S. travel required (up to 5% - 10% of time)