Claims Representative Trainee Workers Compensation Jobs

No experience is necessary - insurance, business or customer service experience is preferred.

Bachelor’s degree preferred or equivalent experience.

Working knowledge of MS Office applications.

Assist customers that have been involved in an auto accident.

Conducts a prompt, thorough and fair investigation by obtaining relevant facts to determine coverage, origin, and extent of loss.

Confirms or denies coverage of the claim based on the facts and the policy terms and conditions.

Manage existing workloads effectively to achieve quality and quantity production goals while providing superior customer service.

Control file-related expenses through efficient utilization and monitoring of "outside" vendors.

Inform other departments of positive/negative conditions noted during investigations which may impact company results.

Education & Licensing: 3+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.

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

Professional certification as applicable to line of business preferred.

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.

Proficient oral and written communication skills

Proficient interpersonal and organizational skills

Independent, Sound decision-making and problem-solving skills

Applying for this job indicates your acknowledgement and understanding of the following statements:

Routing claim issues to next level or appropriate support areas; following up to ensure completion.

Inputting, reviewing and validating the claims data received; evaluating their reliability and effectiveness in line with coverage and appraisal.

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

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.

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

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

Claims Trainees gain the skills & experience to succeed at:

We offer our staff career advancement possibilities

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

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

Contact and establish a rapport with customer, injured party or property owner to obtain information. Comply with 24-hour contact requirements.

No claims experience required but two years of business experience preferred

Computer knowledge, especially Microsoft Word and Excel, desired

Obtain all relevant facts to determine coverage, liability or compensability on claims files.

Determine and analyze damages through appraisal, inspection and investigation.

Evaluate information to assess proper resolution of claims to determine appropriate and fair payout.

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

Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.

Excellent oral and written communication skills.

Individual must be a self-starter with strong organizational abilities.

Investigate and adjust workers compensation claims in accordance with established claims handling procedures using CCMSI guidelines and direct supervision.

Negotiate settlements with claimants and attorneys in accordance with client's authorization.

Assist in selection and supervision of defense attorneys.

Negotiate and direct settlements under management's review

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

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

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

Claims Trainees gain the skills & experience to succeed at:

We offer our staff career advancement possibilities

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

Instead of the above, a minimum combined total of five years of work experience and/or college education

Instead of a degree, a minimum of five years of relevant work experience

Duties & Responsibilities After Training

Research policy contract, regulation and cause of injury to make coverage decisions

Conducts research to understand correlations between medical records and motor vehicle accidents, injuries or medical conditions

Identify and research wage loss expenses and documentation for payment consideration