Workers' Compensation Associate Claim Representative - Eastern Alliance

Responsibilities

• Responds to calls from policyholders, injured workers and providers and directs medical care, where jurisdictionally appropriate, for the unassigned medical only claims.
• Reviews medical invoices for unassigned medical only claims. Contacts insureds, injured workers and/or medical providers as necessary to investigate and approve appropriate invoices for payment within established timeframes.
• Promptly investigates all assigned claims to establish trust and rapport with all parties, accurately assess coverage, determine the nature and extent of the injuries sustained, and reinforce Return to Wellness expectations. Make fair and timely determinations of compensability. Demonstrate empathy, professionalism, integrity, and objectivity at all times.
• Prepare reports and forms as required by jurisdictional regulations and by the Company’s established procedures. Promptly establish and maintain case reserves that accurately reflect the anticipated financial exposure on each claim; revise reserves promptly based on changes in facts and circumstances. Identify subrogation potential.
• Complete ongoing claim management activities proactively and with a sense of urgency in accordance with the ecovery® Return to Wellness philosophy to execute the established plan of action and achieve favorable outcomes for all parties.
• Maintain, cultivate, and develop high quality, collaborative working relationships with all parties, including injured workers, agents, customers, and co-workers. Maintain regular contact by telephone and correspondence with all parties. Seek complete information necessary to manage claims and achieve favorable outcomes. Respond to inquiries in a timely, courteous, and professional manner.
• Proactively seek coaching and guidance to develop technical knowledge and skills. Work collaboratively with supervisor/manager to establish and follow a meaningful professional development plan in order to prepare for promotional opportunities within the Company or to excel in this position.
• Seek out professional growth and development opportunities through attendance and participation in insurance related events, functions, seminars, classes and conferences.
• Aid in special projects as assigned.
• Occasionally travel to customer, agency and industry meetings.
• Participate in department meetings and other duties as assigned.

Qualifications

• Bachelor’s degree is preferred; a HS Diploma/GED with a minimum of eight years of experience working in a medical, legal or an insurance environment can replace the degree requirement.
• Basic knowledge of medical terminology, common medical procedures and treatments preferred.
• Some knowledge of applicable state laws and industry standards preferred.
• Ability to attend insurance and industry/business functions to promote and present a positive image of the Company.
• Proficiency in Microsoft Office computer applications; ability to learn new computer software applications.
• Empathic listener with the ability to listen and respond to another person in a way that engenders mutual understanding and trust.
• Advanced analytical ability, to analyze and interpret information; and make profitable decisions regarding claims payments.
• Excellent organizational and time management skills.
• Solid analytical and problem-solving skills, including formulating logical and objective conclusions.
• Ability to assess the urgency and importance of a situation and take appropriate action.
• Ability to communicate effectively and professionally both verbally and in writing with various constituencies and at all levels; both in and outside of the organization including agency partners, outside customers and clients.
• Ability to maintain confidential information.