Claims Representative III

Responsibilities

• Analyze and manage complex workers’ compensation claims, including reviewing, investigating, and making decisions regarding coverage, compensability, and appropriateness of claims.
• Process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions.
• Act in a fiduciary role on behalf of policyholders.
• Negotiate claim settlements.
• Conduct handling of claims in the utmost of good faith in compliance with rules, regulations, and state statutes.
• Analyze and process workers’ compensation claims by investigating and gathering information to determine the exposure on the claim.
• Negotiate settlement of claims up to designated authority level and make claims payments.
• Calculate and assign timely and appropriate reserves to claims and continue to manage reserve adequacy throughout the life of the claim.
• Calculate and pay benefits due; approve all claim payments; and settle claims within designated authority level.
• Develop and manage claims through well-developed action plans; continue to work the action plan to bring the