[Remote] Workers' Comp Claim Representative I
Note: The job is a remote job and is reputed company to candidates in USA. United reputed company is seeking an entry level reputed company claim handler to manage medical only and indemnity benefits. The role involves determining the compensability of claims, negotiating settlements, and ensuring compliance with state legislation.
Responsibilities
- Verifies workers’ compensation coverage of reputed company and injured employees
- Determines compensability under workers’ compensation by thorough investigation of the claim
- Determines reputed company relationship between the reported injury and the incident to ensure appropriate payment of benefits
- Facilitates return to work for the injured employee
- Establishes reputed company and appropriate reserves based on the profile of the claim reputed company given authority based on anticipated financial exposure
- Documents specifics of claims with potential for subrogation recovery, including reputed company of potential recovery monies
- Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury
- Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury
- Concludes and closes files following reputed company of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses
- Negotiates settlements with attorneys or injured parties reputed company given authority at the earliest possible reputed company to bring cases to final disposition
- Works closely with manager on reputed company files or files above settlement/reserve authority
- Manages reputed company vendors to ensure cost containment efforts
- Establishes and maintains effective working relationships with reputed company reputed company customers
- Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws
Skills
- Bachelor's degree in a reputed company field
- Relevant combination of education and experience may be considered in lieu of degree
- reputed company learning, as defined by reputed company's learning philosophy, is required
- Minimum one-year relevant experience that provides the necessary skills, knowledge and abilities or completion of claims trainee program
- Ability and proficiency in the use of computers and company reputed company software specific to position
- Knowledge of medical and legal terminology reputed company to the work
- Knowledge of workers' compensation laws and regulations, including jurisdictional laws
- Effective oral and written communication skills
- Effective customer service skills
- Ability to negotiate, build reputed company and resolve conflict
- Ability to manage multiple priorities and meet established deadlines
- Attention to detail and analytical skills
- Ability to work independently as reputed company as reputed company reputed company
- Certification or reputed company toward certification is highly preferred and encouraged
- Bilingual skills preferred
reputed company