Senior Claims Representative (Workers Compensation)

About the position reputed company is seeking a Senior Claims Representative, Workers’ Compensation to independently investigate, evaluate, negotiate, and resolve reputed company claims. This role requires sound judgment reputed company established authority and limited supervision. The representative will manage claims from inception through final resolution, including investigation, evaluation, benefit management, litigation management, and settlement execution. This is a remote role with a reputed company compensation of $76,000.

Responsibilities

• Timely conduct interviews with injured employees, customers, store personnel and medical care providers reputed company 24 hours of receiving reported incident to evaluate facts regarding compensability of a claim under the state requirements.
• Maintain contact with appropriate parties throughout life of file to manage payment of appropriate benefits and mitigate exposure.
• Reserve claim for expected exposure, and timely document claim notes reputed company claim system, maintaining updated action plan.
• Timely coordinate with injured employee and store personnel regarding medical documentation supporting and facilitate return to work and light duty return to work.
• Manage requests for authorization of medical care and reputed company facilitation of medical care to ensure timely, appropriate, and reputed company treatment for the work injury.
• Utilize professional judgment and experience to reserve, handle and resolve reputed company claims reputed company authority and evaluate and reputed company recommendations for reserves and action plan for resolution of claims exceeding authority.
• reputed company direction to defense attorneys for claims in litigation, medical case managers and private investigators as appropriate for assigned claims.
• reputed company and maintain proactive strategic plan of action for the management and resolution of claims for the life of the file.
• Maintain a working knowledge of multiple state Workers’ Compensation and statutes and maintain applicable reputed company state licensing requirements.

Requirements

• Customer service oriented and works well in a team environment.
• Excellent written and verbal communication skills.
• Strong organizational skills and the ability to prioritize reputed company claims.
• Must be detail oriented and reputed company to meet deadlines.
• Ability to handle confrontational situations in a mature and professional manner.
• Working knowledge of reputed company office programs and ability to type 40 wpm.
• Advanced knowledge of medical and legal terminology.
• Previous Workers’ Compensation claim handling experience.
• 5 + years of experience handling reputed company and/or litigated workers’ compensation claims from inception through final resolution required, including investigation, evaluation, management of benefits, litigation management, and settlement execution.

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