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Workers Compensation Claims Representative

Location: Mount Pleasant
Posted on: September 10, 2020

Job Description:

Workers Compensation Claims Representative



PRIMARY PURPOSE: To analyze complex or technically difficult claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.



ESSENTIAL FUNCTIONS and RESPONSIBILITIES


?Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.


?Assesses liability and resolves claims within evaluation.


?Negotiates settlement of claims within designated authority.


?Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.


?Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.


?Prepares necessary state fillings within statutory limits.


?Manages the litigation process; ensures timely and cost effective claims resolution.


?Coordinates vendor referrals for additional investigation and/or litigation management.


partnerships to reduce overall cost of claims for our clients.


?Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.


?Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.


?Ensures claim files are properly documented and claims coding is correct.


?Refers cases as appropriate to supervisor and management.



We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

Keywords: , Mount Pleasant , Workers Compensation Claims Representative, Accounting, Auditing , Mount Pleasant, South Carolina

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