Claims Representative Workers Compensation Jobs

Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.

Excellent oral and written communication, including presentation skills

Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.

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.

Organizational skills – attention to detail, time management, focus on priorities, thoroughness, follow up

Click Here to review our U.S. Eligibility Requirements

Learning to investigate claims with overall instruction, exposure and preparation

Analyzing & evaluating claims to make appropriate decisions & recommendations

Effectively communicating with clients and contacts

Continuous learning – understands before making judgements and acting, asks appropriate questions, learns from others and passes state specific licensing exams

Education & Licensing: 2+ years of claims management experience or equivalent combination of education and experience required.

Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Professional certification as applicable to line of business preferred.

Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.

Bachelor's Degree/or equivalent in Risk Management, Business, Finance, or related field.

Verbal and written communication skills necessary to communicate with all levels of management and third-party providers

Apply aggressive litigation cost management strategy on individual WC claim files

Adhere to quality management and compliance protocols

Ensure WC vendors are complying with service instructions and guidelines and escalate specific issues to Manager

Confirm initial and ongoing TPA reporting of WC claims requiring excess notification, and escalate claims meeting defined criteria to Manager

Litigation management - Direct, manage, and control the litigation process.

Handles other duties and tasks as deemed appropriate by the Supervisor or Manager.

Initiate the referral to the SIU of cases with suspected fraud.

Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.

Review and approve all vocational rehabilitation plans.

Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.

Advising employers on the proper management and impact of Workers’ Compensation claims

Healthcare benefits begin on your first day of employment

Hybrid work schedule: Three days in the office, two days from home

The prompt provision of benefits and assistance in early return to work

Computer Literacy with strong Microsoft Office capabilities

Excellent communication and organizational skills

Litigation Management - Direct, manage, and control the litigation process.

Handles other duties and tasks as deemed appropriate by the Supervisor or Manager.

Initiate the referral to the SIU of cases with suspected fraud.

Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.

Review and approve all vocational rehabilitation plans.

Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.

Ability to attain all applicable state licenses within 30 days of hire and maintain appropriate continued education requirements

Notifies the Claim Manager/Supervisor of claims which require assignment to higher level Claims team members

Three years of claims support experience or related experience

Basic knowledge of insurance and claims processing

Strong knowledge of insurance and claims terminology

Good knowledge of computers, software, and applications

Maintain Continuing Education requirements as required.

Apply knowledge to determine causal relatedness of medical conditions.

If controverted or coverage is unconfirmed, retain and manage assigned claims to conclusion.

Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment.

Manage litigation to drive files to an optimal outcome.

3+ years Workers Compensation claim handling experience preferred.

Apply your examiner, knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Professional certification as applicable to line of business preferred.

Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.

Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

Education & Licensing: 8+ years of claims management experience or equivalent combination of education and experience required.

Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

Compiles reviews and analyzes management reports and takes appropriate action.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Licensing / Jurisdiction Knowledge: Active adjuster license preferred and experience handling CA Workers Compensation Claims.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Excellent verbal and written communication skills, time management and organizational skills.

Manages and approves payment of benefits within designated authority level.

Refers cases as appropriate to supervisor and management.

Minimum 1 year of insurance or claims related experience; or equivalent combination of education and experience required.

Assesses claims fairly and equitably, acting in the best interest of all parties and providing benefits as prescribed by law.

High school diploma or general education degree (GED) required.

Litigation management - Direct, manage, and control the litigation process.

Handles other duties and tasks as deemed appropriate by the Supervisor or Manager.

Initiate the referral to the SIU of cases with suspected fraud.

Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.

Review and approve all vocational rehabilitation plans.

Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.

Negotiate and direct settlements under management's review

Effectively manage a caseload of loss time claims from numerous jurisdictions, including NY, PA, MA, NJ, MD, and TN.

A minimum of three years' experience required

Experience handling claims in NY, PA, MA, NJ, MD, or TN

Experience in handling lost time or litigated claims

Demonstration of strong organizational, problem solving, negotiation, and conflict resolution skills

Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Professional certification as applicable to line of business preferred.

Opportunity to work in a remote or agile environment.

Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.

3+ years of experience handling Workers Compensation Indemnity claims from inception to close

Excellent verbal and written communication skills

Ability to work remotely with minimal supervision

CO or UT jurisdictional background

3+ years of experience handling Workers Compensation Indemnity claims from inception to close

Excellent verbal and written communication skills

Ability to work remotely with minimal supervision

CO or UT jurisdictional background

•Experience of 5 years of claims management experience or equivalent combination of education and experience required.

•Coordinates vendor referrals for additional investigation and/or litigation management.

•Refers cases as appropriate to supervisor and management.

•Analyze complex or technically difficult workers' compensation claims to determine benefits due.

•Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements.

•Manages the litigation process; ensures timely and cost effective claims resolution.

2- 5+ years of experience handling primarily Lost time claims.

Excellent Customer Service and Organizational skills

Flex schedule and ability to work remotely

Must Hold Active License in Fl, TX

$ 72,000 - $ 84,000 annual salary

Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Professional certification as applicable to line of business preferred.

Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.

Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.