Analyze reported less complex workers compensation claims to determine benefits due
Ensure ongoing adjudication of claims within company standards and industry best practices
Adjust medical-only claims and minor lost-time workers compensation claims under close supervision
Support other claims representatives, examiners and leads with larger or more complex claims as necessary
Process workers compensation claims determining compensability and benefits due
Monitor reserve accuracy, and file necessary documentation with state agency
Communicate claim action/processing with claimant, client and appropriate medical contact
Ensure claim files are properly documented and claims coding is correct
May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims
Maintain professional client relationships

High school diploma required
One (1) year of general office experience or equivalent combination of education and experience required
Paralegal expertise for handling claims, appeals, and compliance matters
Strong knowledge of workers’ compensation legislation and health & safety standards
Proven ability to manage complex claims processes and collaborate with stakeholders
Experience in HR leave programs, disability case management, and policy interpretation
Excellent oral and written communication skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Ability to work in a team environment

Workers Compensation Consultant – Level 1

Key skills