Claims Representative II

About the role

Pinnacol Assurance provides workers' compensation protection to Colorado employers and employees. The role involves managing indemnity claims and ensuring efficient, cost-effective resolutions.

Responsibilities

• Strategically and proactively manage indemnity claims and related issues.
• Provide quality customer service to all stakeholders, including proactive communication and follow-through.
• Identify and address complex claims, escalating to appropriate levels or securing resources.
• Determine compensability according to Company best practices, case law, and the Colorado Workers' Compensation Act.
• Manage open claims through medical, disability, and litigation management, addressing adverse claim developments.
• Coordinate resources and oversee all necessary actions for optimal claim management.
• Communicate with stakeholders, including policyholders, injured workers, medical providers, and regulatory agencies.
• Facilitate early return to work and benefit authorization/payment for compensable claims.
• Evaluate claims for settlement, negotiate with legal counsel or directly with workers, and prepare settlement documents.
• Inform policyholders and agents of claim status and significant developments.
• Analyze medical records, determine appropriate medical referrals, and authorize payments or deny bills.
• Evaluate medical bill referrals and communicate decisions to billers and parties involved.
• Prepare for and attend settlement conferences and hearings.
• Process records as required by Company documented best practices.

Requirements

A successful candidate will have 1 or more years of experience managing workers' compensation claims, with proficiency in resolving medical claims. Proficiency in applying Colorado jurisdictional requirements and foundational skills (statutory understanding, basic calculations) is essential.

Qualifications

• Strong communication and problem-solving skills.
• Ability to manage multiple tasks and prioritize effectively.
• Knowledge of Colorado Workers' Compensation Act and case law.
• Experience with medical claims management.
• Proficiency in Microsoft Office applications.

Skills

• Excellent communication and interpersonal skills.
• Strong organizational and time management skills.
• Ability to handle sensitive and confidential information.
• Proficiency in medical terminology and understanding of workers' compensation regulations.

Benefits

• Comprehensive health, dental, and vision insurance.
• Flexible vacation and holiday schedule.
• On-site fitness facilities and wellness programs.
• Professional development opportunities.
• Volunteer time off and community involvement.
• Quarterly incentive program based on team performance.

Pay

$66,500 - $71,800 USD

Schedule

Full-time position.