Analyze Workers Compensation claims for clients to determine benefits due while ensuring ongoing adjudication within service expectations. Collaborate to deliver innovative customer - facing solutions within an energetic culture.
About the role
- Claims Representative adjudicating multi-state workers compensation claims for a global leader in risk management. Joining a caring culture that values empathy and professional growth.
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.
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.
- Jurisdiction: Multi State - 15 states Licensing: Required - TX/FL/OK/LA preferred
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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