Workers Compensation Claims Representative

Responsibilities

• Assess incoming reports, notices, and supporting documentation related to workplace injuries and occupational illnesses, and process assigned claims in accordance with established guidelines.
• Review medical and related billing from providers such as physicians, clinics, hospitals, and pharmacies, and authorize eligible payments for claims that do not involve indemnity benefits.
• Evaluate reimbursement requests from injured employees for travel and out-of-pocket medical expenses connected to accepted work-related conditions, and approve payments when appropriate.
• Partner with nurse case management and other clinical resources to clarify questionable injury circumstances, treatment plans, or the need for additional medical review.
• Secure prior medical documentation when needed to support claim handling decisions or to assist physician and nurse consultants in evaluating treatment history.
• Set and maintain claim reserves in a timely manner, and obtain management approval before making reserve increases or payments above delegated authority limits.
• Keep claimants and member organizations informed of claim progress, payment activity, and key processing updates through clear and effective communication.
• Escalate files involving questionable compensability, potential lost-time exposure, subrogation opportunities, restitution matters, or possible property and casualty implications to the claims manager for further direction.
• Prepare and submit restitution-related affidavits when applicable, and monitor follow-up actions to support recovery efforts.

Requirements

• Experience handling workers’ compensation claims, insurance follow-up, or related claims administration in a regulated environment.
• Knowledge of medical billing, patient accounting, payment review, and invoice processing tied to occupational injury claims.
• Ability to interpret claim documentation, evaluate reimbursement requests, and apply sound judgment when determining when issues should be escalated.
• Familiarity with preauthorization processes, medical record review, and coordination with clinical professionals such as nurse case managers or physician consultants.
• Strong data entry skills with the ability to maintain accuracy in a high-volume processing environment.
• Effective verbal and written communication skills for interacting with claimants, members, healthcare providers, and internal leadership.
• Strong organizational skills with the ability to manage multiple claim files, deadlines, and payment activities simultaneously.

Qualifications

Experience handling workers’ compensation claims, insurance follow-up, or related claims administration in a regulated environment.

Knowledge of medical billing, patient accounting, payment review, and invoice processing tied to occupational injury claims.

Ability to interpret claim documentation, evaluate reimbursement requests, and apply sound judgment when determining when issues should be escalated.

Familiarity with preauthorization processes, medical record review, and coordination with clinical professionals such as nurse case managers or physician consultants.

Strong data entry skills with the ability to maintain accuracy in a high-volume processing environment.

Effective verbal and written communication skills for interacting with claimants, members, healthcare providers, and internal leadership.

Strong organizational skills with the ability to manage multiple claim files, deadlines, and payment activities simultaneously.

Skills

Experience handling workers’ compensation claims, insurance follow-up, or related claims administration in a regulated environment.

Knowledge of medical billing, patient accounting, payment review, and invoice processing tied to occupational injury claims.

Ability to interpret claim documentation, evaluate reimbursement requests, and apply sound judgment when determining when issues should be escalated.

Familiarity with preauthorization processes, medical record review, and coordination with clinical professionals such as nurse case managers or physician consultants.

Strong data entry skills with the ability to maintain accuracy in a high-volume processing environment.

Effective verbal and written communication skills for interacting with claimants, members, healthcare providers, and internal leadership.

Strong organizational skills with the ability to manage multiple claim files, deadlines, and payment activities simultaneously.

Benefits

Medical, vision, dental, and life and disability insurance.

Access to top jobs, competitive compensation and benefits.

Free online training.

Company 401(k) plan.

Stay on top of every opportunity - whenever you choose - even on the go.

1-tap apply, notifications of AI-matched jobs, and much more.

All applicants applying for U.S. job openings must be legally authorized to work in the United States.

Equal Opportunity Employer.

M/F/Disability/Veterans.

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies.

We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Robert Half works to put you in the best position to succeed.

We provide access to top jobs, competitive compensation and benefits, and free online training.

Stay on top of every opportunity - whenever you choose - even on the go.

Download the Robert Half app and get 1-tap apply, notifications of AI-matched jobs, and much more.

All applicants applying for U.S. job openings must be legally authorized to work in the United States.

Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance.

Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan.

Visit roberthalf.gobenefits.net for more information.

© 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans.