Claims Representative - Workers Compensation

Education & Licensing:
•High School Diploma or GED.
• Bachelor's degree from an accredited college or university preferred.

Experience:
• Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.

Skills & Knowledge:
• Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices, and Social Security and Medicare application procedures as applicable to the line of business
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations

The client is looking for a candidate who can process low-level workers' compensation claims to determine benefits due, to ensure ongoing adjudication of claims within company standards and industry best practices, and identify subrogation of claims and negotiate settlements with general supervision. This position is on-site if the candidate does not have SIP, but remote(within CA) if they have SIP and experience

Essential Functions and Responsibilities:
• Processes low-level workers' compensation claims, determining compensability and benefits due on long-term indemnity claims, monitors reserve accuracy, and files necessary documentation with the state agency.
• Develops and coordinates low-level workers' compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
• 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.
• May process low-level lifetime medical and/or defined period medical claims, which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

Additional Functions and Responsibilities:
• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**