To process low level workers compensation claims to determine benefits due
Ensure ongoing adjudication of claims within company standards and industry best practices
Identify subrogation of claims and negotiate settlements with general supervision
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.

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

Claims Representative – Workers Compensation

Key skills