Claims Representative - Workers' Compensation

About the role

The Claim Representative manages workers’ compensation claims from investigation to resolution, ensuring compliance with laws and policies.

Responsibilities

• Investigate, evaluate, and manage claims efficiently and fairly.
• Serve as the primary contact for injured workers, employers, and medical providers, maintaining clear communication.
• Conduct thorough investigations by gathering statements, reviewing medical records, and analyzing reports.
• Make prompt decisions on claim acceptance, denial, or settlement based on case facts and legal guidelines.
• Maintain detailed documentation of all activities and communications.
• Monitor and control claim costs, including medical and legal expenses, while establishing appropriate reserves.
• Ensure compliance with relevant workers’ compensation laws and regulations.
• Provide excellent customer service by addressing inquiries and updating claim statuses.
• Collaborate with legal, medical, and risk management teams to achieve optimal outcomes.

Requirements

• Strong investigative, decision-making, and communication skills.
• Knowledge of workers’ compensation laws.
• Detail-oriented.
• Ability to work collaboratively.
• Commitment to compliance and customer service.