Workers Compensation Claims Representative Jobs

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

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.

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.

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

Ensures timely denial or payment of benefits in accordance with jurisdictional requirements

Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition

Maintains a working knowledge of jurisdictional requirements and applicable case law for each state serviced

Strong verbal, written communication skills and customer service skills gained through previous work experience

Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome

Authorizes treatment based on the practiced protocols established by statute or the PMA Managed Care department

Ensure timely denial or payment of benefits in accordance with jurisdictional requirements

Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition

Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced

Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome

Authorize treatment based on the practiced protocols established by statute or the PMA Managed Care department

Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry required

1. Candidates may substitute additional general clerical experience on a year-for-year basis for the required education.

1 year of data entry experience

6 months experience in workers' compensation laws and regulations

1 year experience with workers’ compensation claims

1 year experience working with insurance companies/agencies

Intermediate skills in Microsoft Office (Word, Excel, Outlook and PowerPoint)

Bachelor`s degree or equivalent in addition to 1-year claims handling experience. Knowledge of legal liability, insurance coverage and medical terminology preferred.

Manages an inventory of claims to evaluate compensability/liability.

Proven interpersonal, analytical and negotiation abilities required.

Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.

Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.

Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.

Experience: Clerical or customer service experience or equivalent combination of education and experience preferred

A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more

An assigned mentor and manager who will guide you on your career journey

Career development and promotional growth opportunities through increasing responsibilities

A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs

Education & Licensing: High school diploma or GED required

Negotiate and direct settlements under management's review

Effectively manage a caseload of loss time claims from numerous jurisdictions, including FL

A minimum of three years' experience required

Experience in handling lost time or litigated claims in Florida

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

Excellent verbal and written communication skills needed

Bachelor`s degree or equivalent in addition to 1-year claims handling experience. Knowledge of legal liability, insurance coverage and medical terminology preferred.

Manages an inventory of claims to evaluate compensability/liability.

Proven interpersonal, analytical and negotiation abilities required.

Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.

Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.

Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.

Other duties as assigned by management

Great customer relations skills and experience

1+ years of payroll processing experience preferred

Excellent written and verbal communication skills

Process bi-weekly payroll for all Copart entities in North America

Resolve payroll discrepancies by collecting and analyzing information

Bachelor`s degree or equivalent in addition to 1-year claims handling experience. Knowledge of legal liability, insurance coverage and medical terminology preferred.

Manages an inventory of claims to evaluate compensability/liability.

Proven interpersonal, analytical and negotiation abilities required.

Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.

Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.

Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.

Thorough knowledge of claims processing. Strong verbal and written communication skills.

Strong organizational skills and ability to manage multiple tasks simultaneously.

Serve as resource of process and system knowledge to department.

Associate Degree or equivalent work experience. 3+ years business experience with Washington State Self Insured Workers' Compensation preferred.

Ability to work independently and make sound judgments; demonstrated problem solving skills.

Request wages and complete wage calculations.

Negotiate and direct settlements under management's review

Effectively manage a caseload of loss time claims from numerous jurisdictions, including California

A minimum of three years' experience required

Experience in handling lost time or litigated claims

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

Excellent verbal and written communication skills needed