About this role
Role Overview
- Attendance and completion of designated claims professional training program.
- Adjusting various levels of workers’ compensation claims under close supervision, which includes: Processing and responding to incoming mail, and other claim-related documents according to status of the claim.
- Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives, primarily through telephonic, video conference and email.
- Thoroughly investigating new and existing claims by gathering relevant information including medical records, employer reports, and witness statements.
- Investigating employer/employee relationships, policy verification, coverage and any potential for subrogation issues or fraud indicators.
- Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements.
- Documenting claims files and properly coding claim activity.
- Preparing detailed reports documenting findings and recommendations.
- Administering claim benefits, ensuring state compliance.
- Participating in virtual and/or in-person meetings, claim reviews and business functions as needed.
Requirements
- High School Diploma or GED
- No experience required
Benefits
- medical
- dental
- vision
- 401k
- matching
- PTO
- disability
- life insurance
- employee assistance
- flexible spending or health savings account
- additional voluntary benefits