About this role
Role Overview
- Attendance and completion of designated claims professional training program
- Adjusting various levels of workers’ compensation claims under close supervision, which includes: Processing and responding to incoming mail, emails and other claim related documents according to status of the claim
- Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives, primarily through telephonic, video conference and email
- Thoroughly investigating new and existing claims by gathering relevant information including medical records, employer reports, and witness statements
- Investigating employer/employee relationships, policy verification, coverage and any potential for subrogation issues or fraud indicators
- Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements
- Documenting claims files and properly coding claim activity
- Preparing detailed reports documenting findings and recommendations
- Administering claim benefits i.e., indemnity and medical benefits, through maintenance of calendared claim-related action items, ensuring state compliance
- Participating in virtual and/or in-person meetings, claim reviews and business functions as needed for educational training, claim discussions and various meetings
Requirements
- Education Requirement – High School Diploma or GED
- Bachelor's degree preferred and 2 years of customer service experience and/or combination of education and experience
- No experience required
Benefits
- A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs including medical, dental, vision & 401k
- PTO
- disability and life insurance
- employee assistance
- flexible spending or health savings account
- other additional voluntary benefits