Claims Representative

About the role

Pinnacol Assurance provides workers' compensation protection to Colorado employers and employees. Founded over 100 years ago, the company focuses on innovative solutions and compassionate service.

Responsibilities

• Strategically and proactively manage claims and related issues to the most expedient, cost-effective resolution.
• Provide quality customer service to all stakeholders.
• Identify claims needing additional management and work with team members to resolve concerns or escalate to the appropriate level.
• Contact stakeholders as required by Company best practices to promptly investigate accident and injury circumstances, determine compensability, and address red flag issues.
• Determine compensability as required by Company best practices, case law, and the Colorado Workers' Compensation Act.
• Proactively manage open claims as required by Company best practices, including medical case management, disability management, and litigation management.
• Facilitate all necessary resources for optimal claim management, action plan development, and resolution, including other team members, Leads, Owners, Underwriters, Directors, Consultants, and Specialists.
• Communicate decisions and evaluate for customer understanding.
• Educate and inform policyholders and agents on workers' compensation and the status of individual claims.
• Review medical information to determine authorization/payment appropriateness or referral to other Company resources.
• Prepare for, attend, and testify at settlement conferences and hearings as determined appropriate by leadership.
• Evaluate medical bill referrals and authorize payment or deny bills based on supporting documentation.
• Process records as required by Company best practices.
• Recognize and communicate when a treatment plan is outside of authorized care and assist stakeholders with treatment plan management.
• Serve as a resource to other claims representatives as requested.
• Continue education to manage increasingly complex claims.

Requirements

In addition to the competencies outlined below, a successful candidate will have 2 or more years of previous experience working directly with customers and be comfortable managing difficult conversations. Must be comfortable using technology and multiple systems. Must successfully complete training and claims assessments within six months.

Physical Activities

Regular attendance required. Extensive telephone and computer work in an office environment. Attend marketing visits with agents and/or policyholders as required.

Disclaimer

This description is not an exhaustive list of all duties, responsibilities, or qualifications associated with this job. We can't do our work without people like you. Our employees are extraordinary and committed to making a difference. Here's some of the ways we show our appreciation. Our benefits go beyond the basics. You'll get to choose from diverse benefit offerings for medical, dental, and vision. We care about each other. We enjoy a positive, collaborative work environment. We are hard workers and high performers. We love who you are. Pinnacol is on a journey to embody diversity, equity, and inclusion. We're committed to creating a culture that deeply values differences, where everyone feels like they belong. Take a day (or 20!) off. Enjoy 20 paid days off your first full year plus 9 paid holidays. Get your learning on. We promote a learning culture to help you master your current job and cultivate the skills of the future through a variety of on-site, online, and off-site professional development opportunities. Give back and get paid. Through our employee volunteer program, Pinnacol in Action, employees receive paid time off to volunteer with Colorado nonprofits. Share in our success. You'll have the opportunity to earn a quarterly incentive, up to 12 percent of your annual base salary, when your team exceeds their goals and objectives. When we find the right person, we try to put our best foot forward with an offer that excites you. We consider what you'd like to be paid, the skills and experience you bring, what similar jobs pay in the Denver area, and make sure there's equal pay for equal work among those you'll be working with. The compensation amount for this role is targeted at $60,000 to $64,200. Final offer amounts are determined by multiple factors including your experience and expertise and may vary from the amounts listed above.