Triage Claims Associate

About the role

The Triage Claims Associate for Workers’ Compensation plays a critical role in the initial assessment and routing of a claim. This position is responsible for reviewing incoming claims to determine the severity and urgency, as well as follow-up actions needed by gathering all necessary information and initiating the 3-points of contact during the first 10 days in the life of assigned claims. This role ensures claims files are accurate and complete prior to their transfer to the indemnity claims team.

A key objective of this role is to equip the Associate with the knowledge, skills, and abilities necessary to effectively manage a caseload of 70+ files and successfully complete either the SIP exam or earn the Claims Examiner designation within one year of hire for California. Additional Workers’ Compensation licensing may be required for other jurisdictions, as applicable.

Responsibilities

• Reviews and analyzes incoming workers' compensation claims to determine the severity of the claims, benefits owed, ensures medical treatment is communicated to the injured worker, and reviews the claims file for completeness and accuracy of details.
• Communicates with injured workers, employers, medical providers, and internal teams to gather initial information.
• Documents claim details and triage decisions in the claims management system.
• Identifies potential fraud indicators and escalates as needed.
• Maintains compliance with company policies and state regulatory requirements.
• Supports continuous improvement initiatives within the triage process.

Requirements

• High school diploma or equivalent required; Associate or Bachelor’s degree preferred.
• Minimum 1+ year of related office or customer service experience.
• Prior Workers’ Compensation industry experience highly preferred.

Skills

• Basic understanding of workers compensation terminology and claims processes (preferred).
• Strong organizational and communication skills.
• Adept at computer use including proficiency with online databases and/or claims management software (CXP or related) and Microsoft Office Suite.
• Ability to work in a fast-paced, detail-oriented environment.
• Strong analytical skills and demonstrated attention to detail.
• Good time management skills and follow-through on deliverables.
• Collaborative with a team orientation and works with a sense of urgency for execution of deliverables.

Physical Requirements

Office environment – no specific or unusual physical or environmental demands, and employees are regularly required to sit, walk, stand, talk, and hear.

Work Environment

This position operates in an office environment and requires frequent use of a computer, telephone, copier, and other standard office equipment.

We are currently not offering employment sponsorship for this opportunity.

Pay

The current range for this position is $22.54 - $35.54 per hour, exclusive of fringe benefits and potential bonuses. Your final base salary compensation will be determined by factors unique to each candidate, including experience, education, and the location of the role, and considers employees performing substantially similar work.

Benefits

• Competitive benefits package, including generous medical, dental, and vision plans.
• 401K retirement plans with company match.
• Bonus potential for all positions.
• Paid Time Off.
• Paid holidays throughout the calendar year.
• Support for continuing education and professional development.