Workers' Compensation Claims Representative Primary Responsibility The Claims Representative will manage an assigned caseload of medical only and lost time Workers' Compensation claims from the first report of injury to resolution according to the applicable law. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. The Claims Representative will adjudicate medical only and lost time Workers' Compensation files according to applicable law.
Essential Functions & Responsibilities Manage assigned caseload of workers' compensation claims.
Make decisions about compensability, set reserves and negotiate settlements.
Interact with claimants, clients, medical providers and other third-party representatives throughout the claims process.
Timely initial contacts and investigation of new claims.
Verify coverage.
Take recorded statements as needed.
Document files daily on every conversation and action taken.
Identify and address subrogation issues.
Start and stop indemnity benefits timely and accurately.
Complete jurisdictional forms timely and accurately.
Monitor ongoing medical treatment.
Request second medical opinions as needed.
Work mail and diary on a daily basis.
Client visits as required.
Preparation and handling of hearings
Additional Functions & Responsibilities Communicates directly with client.
Prepares reports and other analytical data as requested by the management team.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required Qualifications:
Must hold a valid Workers' Compensation Adjuster license.
Must have at least 2-3 years of experience handling indemnity workers' compensation claims.
High school diploma.
Ability to follow instructions, procedures and rules.
Must have strong attention to detail.
Must have good written and oral communication skills.
Must have well organized and the ability to multi-task.
Basic computer skills in MS Word, Excel and Outlook.
Preferred Qualifications: College degree in business or other related discipline.
