Claims Specialist
Claims Specialist
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Job Description
- Claims Specialist
Cities and Villages Mutual Insurance Company
Wauwatosa WI - APPLY HERE
WHY JOIN THE CVMIC TEAM:- The ability to make a difference to our municipal clients/members!
- Great variety in what you do each day
- Flexibility with your schedule including the ability to work remotely
- A supportive team environment
- Outstanding benefits that include: Companypaid retirement contribution into a Simplified Employee Pension (SEP) Plan: 12.1% of salary after one year of employment Companypaid health insurance premiums and tuition reimbursement for continued opportunities for growth and development!
View more about CVMIC!
Under the general supervision of the Workers Compensation Claims Manager this position is responsible for investigating processing and adjusting workers compensation claims. Some travel may be required with occasional overnight stays.
Essential Duties & Responsibilities
- Reviews first report of injury forms (WC12) and follow up with claimants insureds medical providers or others in a timely manner todetermine compensability.
- Files required State forms in a timely and accurate manner.
- Processes new claims sets and monitors reserves.
- Maintains up to date files and diaries on all active claims.
- Interviews telephones or corresponds with municipal client/member representatives employees and supervisors claimants witnesses and medical personnel; reviews medical and hospital records in a timely manner to determine compensability while maintaining required confidentiality.
- Recommends and sets up Independent Medical Evaluations Vocational Evaluations and assigns Rehabilitation Nurses as necessary.
- Reviews and pays medical bills and indemnity benefits. Submits medical bills for third party review.
- Identifies and reports claims with reinsurance/excess insurance exposure to the carrier Claims Manager and CEO.
- Exercises discretion within settlement authority to pay deny or settle claims and establish reserves on claims. Exercises discretion with respect to investigating claims and processing medical bills and indemnity payments. Discretion is also required with respect to all Company procedures to allow for the flexibility needed to process claims properly and in a timely manner.
- Recommends litigation when settlement cannot be negotiated; Oversees litigation on contested cases.
- Assigns work provides oversight and reviews files of Claims Assistants and MedOnly Claims Specialist.
- Monitors claims to identify and followup on subrogation opportunities.
- Attends Administrative hearings.
- Conducts claim file review with municipal clients/members.
- Provides Workers Compensation training for municipal clients/members as needed.
Qualifications
To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.- Associates degree (A. A.) or equivalent from twoyear college or technical school;
- Three to five years related experience and/or training; or equivalent combination of education and experience.
Knowledge Skills & Abilities
Knowledge of:
- The principles and practices of workers compensation claims handling.
- Wisconsin Workers Compensation Act Administrative Code and case law.
- Duty disability and long term disability benefits including 40.63 and 40.65.
- Claims software Outlook Excel and Microsoft Word or similar business software.
- Americans with Disabilities Act (ADA) Family & Medical Leave Act (FMLA) and Medicare set aside laws.
- Accurately calculate and verify indemnity payments as required by the Workers Compensation Act and Wisconsin Administrative Code.
- Handle sensitive situations in a professional manner that reflects favorably upon the municipal client/member and Company.
- Communicate professionally timely and effectively both orally and in writing.
- Interact effectively with others inside and outside the organization.
- Accurately and efficiently read analyze and interpret general business periodicals medical reports legal reports and governmental regulations.
- Accurately and efficiently write reports and business correspondence..
- Effectively and professionally present information and respond to questions from clients claimants medical service providers attorneys and representatives from governmental agencies.
- Must possess and maintain a valid Wisconsin drivers license during employment.
- Must be able to provide an automobile with liability insurance limits acceptable to the company.
We Make it Easy
Founded in 1901 MRA is a nonprofit employer association that serves more than 4000 employers covering more than one million employees.
As one of the largest employer associations in the nation MRA helps its member organizations thrive by offering the most comprehensive assortment of HR services information education and resources to help build successful workplaces and a powerful workforce.
We partner with these companies working directly with their HR department and leadership to hire their talent. We are a direct line to the company not an agency recruiter.
Required Experience:
Senior IC
Employment Type
Full-Time
