Senior Claims Representative (Remote)

Essential Duties and Responsibilities

• Manage highly complex claims involving significant financial exposure, legal intricacies, and extended life cycles.
• Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations.
• Oversee medical case management for catastrophic injuries and lifetime care needs.
• Review and authorize large or complex medical bills, negotiating adjustments to control costs.
• Develop comprehensive return-to-work strategies in collaboration with policyholders, legal counsel, and vocational consultants.
• Ensure precision in benefit calculations for high-exposure claims, addressing tax and compliance risks.
• Strategically deploy investigative efforts aligned with broader claims strategy.
• Lead investigations into complex fraud cases and collaborate with the Special Investigations Unit.
• Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery.
• Partner with legal teams to negotiate complex settlements and manage litigation processes.
• Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement.
• Identify opportunities for structured settlements and lead negotiations.
• Produce strategic reports on high-profile claims to guide management decisions.
• Maintain system data integrity and prepare claims for Corporate Plan of Action meetings.
• Collaborate with cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management.
• Resolve escalated customer service issues and support high-value accounts.
• Participate in workflow improvement initiatives and committees.
• Lead cross-departmental efforts to improve claims handling and risk management