Claim Representative – Workers Compensation

Claim Representative – Workers Compensation

Requirements

• Bachelor’s degree from an accredited college or university preferred
• Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required
• Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations

Responsibilities

• Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency
• Develops and coordinates low level workers compensation claims’ action plans to resolution, return-to-work efforts, and approves claim payments
• Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract
• Administers subrogation of claims and negotiates settlements
• Communicates claim action with claimant and client
• Ensures claim files are properly documented and claims coding is correct
• May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
• Maintains professional client relationships
• Performs other duties as assigned
• Supports the organization’s quality program(s)
• Travels as required

Preferred Qualifications

• Bachelor’s degree from an accredited college or university preferred