Workers Compensation Claims Representative Jobs in Atlanta, Cass, Texas

Provide WC claims’ management education and WC regulatory updates to local business units.

Bachelor’s degree in Risk Management, Finance or Nursing background preferred

Ability to effectively work and collaborate with people with a wide range of skills, experience, cultures, and capabilities

Other duties as directed by management

Minimum seven (7) years of experience managing WC claims

WC technical knowledge and WC case law in multiple jurisdictions from Ohio to California

Manage all aspects of claims to resolution in accordance with jurisdictional requirements

Obtain appropriate state adjuster certification and continuing education credits

Establish appropriate claim reserve and manage reserve adequacy throughout life of claim

Negotiate skillfully in difficult situations to win concessions without damaging relationships

Minimum 3 years progressive work experience in administrative role

Bachelor's Degree in relevant field or equivalent work experience

Process payment of medical bills and invoices, meeting all statutory timeliness requirements

Minimum of one year of progressive office administration experience

Knowledge of workers’ compensation terminology preferred

Communicate with injured workers and service providers to facilitate claims administration

Provide injured workers with information about the workers’ compensation process

Handle multiple priorities simultaneously and effectively prioritize tasks to meet deadlines

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.

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

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.

Five (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.

SkillsQualifications: Bachelor's degree from an accredited college or university preferred

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

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

Experience applying laws, rules, regulations, policies, and procedures when reviewing claims for benefits

Experience adjudicating highly complex cases for benefits based on evidence.

Experience reviewing reconsideration requests or appeals for benefits.

Requires a probationary period if the requirement has not been met.

Experience making and issuing final decisions that affirm or remand cases for further development

Reviews claimant requests for reconsideration of final decisions with delegated authority to finalize or modify decisions of the initial claims examiner.

C (Download PDF reader)lick here to view Minimum Qualification Specification (Download PDF reader)

Click here to view Minimum Qualification Specification (Download PDF reader)

o qualify, you must meet all of the following requirements:

Professional Trainee II: SR-18, Salary $4,339 per month

Professional Trainee I: SR-16, Salary $4,011 per month

Consideration may be given to lower levels:

Provide WC claims’ management education and WC regulatory updates to local business units.

Bachelor’s degree in Risk Management, Finance or Nursing background preferred

Ability to effectively work and collaborate with people with a wide range of skills, experience, cultures, and capabilities

Other duties as directed by management

Minimum seven (7) years of experience managing WC claims

WC technical knowledge and WC case law in multiple jurisdictions from Ohio to California

Leadership ability and demonstrated time management skills to delegate work appropriately and organize resources effectively.

Manages an inventory of workers compensation claims to evaluate compensability/liability.

Excellent interpersonal skills to communicate and negotiate with customers and conduct investigations 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 compensability.

Performs other duties as assigned.

If you are relying on your education to meet qualification requirements:

Prepares reports and provides data advising management of new trends in the hearing program.

Requires a probationary period if the requirement has not been met.

Drafting and/or signing final decisions or briefs to claimants who have applied for compensation benefits.

Analyze and interpret legal issue(s) to determine entitlement to workers' compensation benefits under federal laws.

You will be evaluated for this job based on how well you meet the qualifications above.

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: 5-7 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

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

Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.

Stay abreast of changes in compliance procedures and identify and communicate compliance process enhancement opportunities to management

Cultivate and maintain relationships with internal and external customers

Gather, analyze, and distribute compliance information to satisfy needs of business partners, and to facilitate appropriate outcomes

Complete assigned daily compliance support activities timely and accurately

Contribute assistance that enhances and enables achievement of compliance objectives by demonstrating teamwork and collaboration to elevate partner and customer service

Look for ways to improve compliance with state and federal laws and regulations

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

Excellent oral and written communication, including presentation skills

Location: United States of America

Expiry Date: 15 September 2023

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

Administers subrogation of claims and negotiates settlements.

Prepares reports and provides data advising management of new trends in the hearing program.

Requires a probationary period if the requirement has not been met.

Drafting and/or signing final decisions or briefs to claimants who have applied for compensation benefits.

Analyze and interpret legal issue(s) to determine entitlement to workers' compensation benefits under federal laws.

Serves as an Agency's independent authority and representative in reviewing claims and rendering appellate level decisions in classified claims.

Serves as the primary point of contact for Federal agencies on workers' compensation claims that contain classified information.

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.

Education: Undergraduate studies in business administration or related field preferred and/or relevant Workers’ Compensation experience.

Other criteria, including leadership skills, competencies and experiences may take precedence.

Registered Nurse (RN) licensure required; Successful completion of required claims certification schools/courses. State licensing where required.

Three or more years of clinical experience required, medical coding or medical billing preferred.

Strong data analysis skills to determine medical bill rule design.

Delivers a positive customer service experience to all internal, external, current and prospective Nationwide customers.

Experience: Five (5) years of claims management experience or equivalent combination of education and experience required.

Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

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

Refers cases as appropriate to supervisor and management.

Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

Calculates TTD, Wage Loss, VRMA and PD benefits

Issues compensation payments on diary schedule

Doctor status calls and Employee/Employer contact calls

Employer contact calls to confirm light duty/modifies work

Works closely with Claims Specialist to complete clerical assignments

Prepares litigation documents such as C&R, Stipulations, Answers, etc

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.

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