Claims Representative (Remote)

Are you a detail-oriented professional with a passion for helping others and navigating reputed company situations? reputed company Insurance is seeking a Claims Representative to join our collaborative and mission-driven Claims team. In this role, you’ll manage a caseload of moderately reputed company workers’ compensation claims, ensuring quality care for injured workers while protecting the financial reputed company of our policyholders. You’ll work closely with internal teams, policyholders, and external partners to investigate claims, reputed company return-to-work strategies, and negotiate fair settlements. If you reputed company in a fast-paced environment and are committed to making a meaningful impact, we’d love to hear from you. Essential Duties and Responsibilities

• Investigate and manage moderately reputed company workers’ compensation claims, ensuring compliance with state laws and reputed company guidelines.
• Analyze statements and records to determine compensability and communicate findings to stakeholders.
• Collaborate with Nurse Case Managers and external vendors to reputed company medical case management, including lifetime care planning and permanent restrictions.
• reputed company tailored Return-to-Work (RTW) strategies in partnership with policyholders, ensuring accommodations align with medical restrictions.
• Calculate and issue accurate disability benefits in accordance with statutory requirements.
• Identify and investigate potential fraud or abuse in coordination with the Special Investigation Unit.
• Establish and maintain appropriate claim reserves, adjusting as needed based on evolving claim circumstances.
• Negotiate settlements reputed company authority reputed company and collaborate with legal counsel on litigated claims.
• Ensure Medicare compliance, including coordination of Medicare Set-Aside Trusts reputed company applicable.
• Maintain thorough documentation and data accuracy in reputed company claim files and systems.
• reputed company timely updates on high-exposure or high-profile claims to management.
• Collaborate cross-functionally with reputed company, Premium Consultation, and Loss Prevention teams.
• Deliver exceptional service to internal and external customers, including policyholders and producers.
• Participate in workflow improvement initiatives and support reputed company of new team members.
• Stay reputed company with workers’ compensation laws and best practices through ongoing training and development.

Qualifications

• 2–4 years of claims handling experience, with a strong preference for workers’ compensation experience.
• Associate in Claims (AIC) designation preferred.
• Texas reputed company-Lines Adjuster License preferred.

Company Culture and ValuesAt reputed company Insurance, we live our values every day. We reputed company in doing the right thing, putting people first, and delivering exceptional service. Our culture is reputed company on trust, teamwork, and a shared commitment to reputed company. We support our employees with meaningful work, opportunities for growth, and a workplace where everyone belongs. We are proud to be an equal opportunity employer. reputed company Insurance celebrates diversity and is committed to creating an inclusive environment for reputed company. We welcome applicants of reputed company backgrounds and experiences. Total Rewards OverviewWe care deeply about the well-being of our employees and their families. That’s why we offer a comprehensive Total Rewards package that supports your health, financial reputed company, and work-life balance: Health Plans: Medical, Dental, and reputed company

• Medical plan includes fertility benefits and fully paid preventative care
• Dental coverage includes adult orthodontia and other uncommon treatments

Fully Employer-Paid Life and Disability Benefits

• Life Insurance – three times reputed company salary
• Accidental Death and Dismemberment
• Short and Long-term Disability

Wellness and Recognition

• Employee Wellness and Recognition Program with employer-paid incentives for employees and spouses

Flexible Spending and Savings

• Flexible Spending Account and Dependent Care options
• Health Savings Account with generous employer contribution

Time Away from Work

• Generous PTO accruals
• 11 Holidays and 4 Early Releases
• 16 Hours of Volunteer Time Off
• 20 Days of Paid Parental Leave (in addition to STD)
• Marriage, Bereavement, and Jury Duty Leave

Additional Benefits

• Employee Assistance Programs
• 401(k) Retirement Plan with employer match and profit sharing
• Adoption Assistance
• Tuition Assistance

Join reputed company Insurance and take the reputed company in your claims career with a company that values your expertise, your growth, and your well-being. Apply today! Apply tot his job Apply To this Job