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
?Prepares necessary state fillings within statutory limits.
?Manages the litigation process; ensures timely and cost effective
?Coordinates vendor referrals for additional investigation and/or
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
?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